| BMC Public Health | |
| Nutritional intervention and physical training in malnourished frail community-dwelling elderly persons carried out by trained lay “buddies”: study protocol of a randomized controlled trial | |
| Karin E Schindler1  Maria Luger2  Ali Kapan3  Eva Luger3  Sandra Haider4  Christian Lackinger4  Thomas E Dorner3  | |
| [1] Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria;Special Institute for Preventive Cardiology And Nutrition SIPCAN, Guggenbichlerstraße 8/15, 5026 Salzburg, Austria;Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria;Department for Health Promotion & Prevention, SPORTUNION Austria, Falkestraße 1, 1010 Wien, Austria | |
| 关键词: Strength training; Physical activity; Malnutrition; Community-dwelling; Frailty; | |
| Others : 1161392 DOI : 10.1186/1471-2458-13-1232 |
|
| received in 2013-12-04, accepted in 2013-12-19, 发布年份 2013 | |
PDF
|
|
【 摘 要 】
Background
In elderly persons frailty and malnutrition are very common and can lead to serious health hazards such as increased mortality, morbidity, dependency, institutionalization and a reduced quality of life. In Austria, the prevalence of frailty and malnutrition are increasing steadily and are becoming a challenge for our social system. Physical training and adequate nutrition may improve this situation.
Methods/design
In this randomized controlled trial, 80 malnourished frail community-dwelling patients (≥ 65 years) hospitalized at wards for internal medicine are recruited. Additionally, 80 lay volunteers (≥ 50 years), named buddies are recruited and subsequently trained regarding health enhancing physical activity and nutrition in four standardized training sessions. These buddies visit the malnourished frail persons at home twice a week for about one hour during an initial period of 10–12 weeks. While participants allocated to the intervention group (n = 40) receive intervention to improve their fluid intake, protein and energy intake, perform strength training and try to increase their baseline activities, the control group (n = 40) only gets home visits without any intervention. After 10–12 weeks, both, the intervention and the control group, receive the nutritional intervention and the physical training. Health, nutritional and frailty status, physical fitness, body composition and chronic inflammation of buddies and frail persons are recorded before the intervention, after 10–12 weeks, 6 and 12 months.
Discussion
To your knowledge this trial is the first of its kind to provide nutritional and physical activity interventions to malnourished frail community-dwelling persons by trained lay buddies, in which an improvement of the frail persons´ and the buddies’ health status is measured. This study assesses the efficacy of such an intervention and may offer new perspectives for the management of frailty and malnutrition.
Trail registration
ClinicalTrials.gov,NCT01991639
【 授权许可】
2013 Dorner et al.; licensee BioMed Central Ltd.
【 预 览 】
| Files | Size | Format | View |
|---|---|---|---|
| 20150413024353584.pdf | 803KB | ||
| Figure 3. | 58KB | Image | |
| Figure 2. | 90KB | Image | |
| Figure 1. | 71KB | Image |
【 图 表 】
Figure 1.
Figure 2.
Figure 3.
【 参考文献 】
- [1]Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004, 59(3):255-263.
- [2]Espinoza S, Walston JD: Frailty in older adults: insights and interventions. Cleve Clin J Med 2005, 72(12):1105-1112.
- [3]Romero-Ortuno R, Walsh CD, Lawlor BA, Kenny RA: A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 2010, 10:57. BioMed Central Full Text
- [4]Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J: Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 2009, 64(6):675-681.
- [5]Böck M, Rieder A, Dorner TE: Frailty. Definition, Erkennung und Bedeutung in der Gesundheitsförderung und Prävention. Linz: OÖ. Gebietskrankenkasse; 2011. [vol. 41]
- [6]Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, et al.: Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 2010, 39(4):412-423.
- [7]Espinoza SE, Fried LP: Risk factors for frailty in the older adult. Clin Geriatrics 2007, 15:37-44.
- [8]Sayer AA, Syddall H, Martin H, Patel H, Baylis D, Cooper C: The developmental origins of sarcopenia. J Nutr Health Aging 2008, 12(7):427-432.
- [9]Thompson DD: Aging and sarcopenia. J Musculoskelet Neuronal Interact 2007, 7(4):344-345.
- [10]Paddon-Jones D, Short KR, Campbell WW, Volpi E, Wolfe RR: Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr 2008, 87(5):1562S-1566S.
- [11]Morley JE: Sarcopenia: diagnosis and treatment. J Nutr Health Aging 2008, 12(7):452-456.
- [12]Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP: The association between obesity and the frailty syndrome in older women: the Women’s health and aging studies. J Am Geriatr Soc 2005, 53(6):927-934.
- [13]Villareal DT, Banks M, Siener C, Sinacore DR, Klein S: Physical frailty and body composition in obese elderly men and women. Obes Res 2004, 12(6):913-920.
- [14]Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB: Frailty: emergence and consequences in women aged 65 and older in the Women’s health initiative observational study. J Am Geriatr Soc 2005, 53(8):1321-1330.
- [15]Soeters PB, Reijven PL, Van der Schueren MA VB-d, Schols JM, Halfens RJ, Meijers JM, Van Gemert WG: A rational approach to nutritional assessment. Clin Nutr 2008, 27(5):706-716.
- [16]Soeters PB, Schols AM: Advances in understanding and assessing malnutrition. Curr Opin Clin Nutr Metab Care 2009, 12(5):487-494.
- [17]Allison SP: Malnutrition, disease, and outcome. Nutrition 2000, 16(7–8):590-593.
- [18]Davison KK, Ford ES, Cogswell ME, Dietz WH: Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. J Am Geriatr Soc 2002, 50(11):1802-1809.
- [19]Dorner TE, Rieder A: Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol 2012, 155(1):56-65.
- [20]Dorner TE, Schwarz F, Kranz A, Freidl W, Rieder A, Gisinger C: Body mass index and the risk of infections in institutionalised geriatric patients. Br J Nutr 2010, 103(12):1830-1835.
- [21]Locher JL, Roth DL, Ritchie CS, Cox K, Sawyer P, Bodner EV, Allman RM: Body mass index, weight loss, and mortality in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2007, 62(12):1389-1392.
- [22]Zizza CA, Herring A, Stevens J, Popkin BM: Obesity affects nursing-care facility admission among whites but not blacks. Obes Res 2002, 10(8):816-823.
- [23]Guigoz Y, Vellas B, Garry PJ: Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 1996, 54(1 Pt 2):59-65.
- [24]Hubbard RE, O’Mahony MS, Calver BL, Woodhouse KW: Plasma esterases and inflammation in ageing and frailty. Eur J Clin Pharmacol 2008, 64(9):895-900.
- [25]Leng SX, Xue QL, Tian J, Walston JD, Fried LP: Inflammation and frailty in older women. J Am Geriatr Soc 2007, 55(6):864-871.
- [26]Puts MT, Visser M, Twisk JW, Deeg DJ, Lips P: Endocrine and inflammatory markers as predictors of frailty. Clin Endocrinol 2005, 63(4):403-411.
- [27]Walston JD: Frailty. UpToDate. [ http://www.uptodate.com/contents/frailty webcite]
- [28]Ble A, Cherubini A, Volpato S, Bartali B, Walston JD, Windham BG, Bandinelli S, Lauretani F, Guralnik JM, Ferrucci L: Lower plasma vitamin E levels are associated with the frailty syndrome: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2006, 61(3):278-283.
- [29]Semba RD, Bartali B, Zhou J, Blaum C, Ko CW, Fried LP: Low serum micronutrient concentrations predict frailty among older women living in the community. J Gerontol A Biol Sci Med Sci 2006, 61(6):594-599.
- [30]Harris D, Haboubi N: Malnutrition screening in the elderly population. J R Soc Med 2005, 98(9):411-414.
- [31]Neelemaat F: Post-discharge nutritional support in malnourished ill elderly patients – effectiveness and cost-effectiveness. Amsterdam, The Netherlands: VU University Medical Center; 2012.
- [32]Beck AM, Kjaer S, Hansen BS, Storm RL, Thal-Jantzen K, Bitz C: Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial. Clin Rehabil 2013, 27(6):483-493.
- [33]Dorner T, Kranz A, Zettl-Wiedner K, Ludwig C, Rieder A, Gisinger C: The effect of structured strength and balance training on cognitive function in frail, cognitive impaired elderly long-term care residents. Aging Clin Exp Res 2007, 19(5):400-405.
- [34]Perrig-Chiello P, Perrig WJ, Ehrsam R, Staehelin HB, Krings F: The effects of resistance training on well-being and memory in elderly volunteers. Age Ageing 1998, 27(4):469-475.
- [35]Wolfson L, Judge J, Whipple R, King M: Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci 1995, 50:64-67.
- [36]Gomes GA, Cintra FA, Batista FS, Neri AL, Guariento ME, Sousa Mda L, D’Elboux MJ: Elderly outpatient profile and predictors of falls. Sao Paulo Med J = Rev Paul Med 2013, 131(1):13-18.
- [37]Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G: Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr 2012, 31(5):652-658.
- [38]Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, Gottdiener J, Fried LP: Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the cardiovascular health study. Arch Intern Med 2002, 162(20):2333-2341.
- [39]Dorner T, Luger E, Tschinderle J, Stein K, Haider S, Kapan A, Lackinger C, Schindler K: Association between nutritional status (MNA®-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients. J Nutr Health and AgingIn press
- [40]Dale O, Salo M: The helsinki declaration, research guidelines and regulations: present and future editorial aspects. Acta Anaesthesiol Scand 1996, 40(7):771-772.
- [41]Schulz KF, Altman DG, Moher D: CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 2011, 9(8):672-677.
- [42]Dorner TE, Tschinderle J, Schindler K: Frailty, Ernährungsstatus und Bereitschaft zu einer Trainings- und Ernährungsintervention bei älteren Personen in Wiener Krankenhäusern. Wien Klin Wochenschr 2011, 123(17–18):A40-A41.
- [43]Mueller M: Pilotstudie zur Einführung eines Buddy-Systems in die Prävention und Therapie von Frailty. Vienna: Medical University of Vienna; 2013. [Diploma Thesis]
- [44]Tschinderle J, Schindler K, Dorner T: Prävalenz von frailty und malnutrition bei personen über 65 jahren in wiener krankenhäusern. [ http://www.pflegenetz.at/index.php?id=82&tx_ttnews%5Btt_news%5D=527&cHash=fc936f9e463b339fc487cd6d1315b4b8&print=1 webcite]
- [45]Randomizer for clinical trials 1.8.1 [ https://www.meduniwien.ac.at/randomizer/web/login.php webcite]
- [46]University H: Healthy eating plate. [ http://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ webcite]
- [47]Miller W, Rollnick S: Motivational interviewing: Preparing people for change, vol. 2nd edition. New York: Guilford Press; 2002.
- [48]Göhner W, Fuchs R: Änderung des Gesundheitsverhaltens. MoVo Gruppenprogramme für körperliche Aktivität und gesunde Ernährung. Göttingen: Hogrefe; 2007.
- [49]Group T: Development of the world health organization WHOQOL-BREF quality of life assessment. The WHOQOL group. Psychol Med 1998, 28(3):551-558.
- [50]Winkler I, Matschinger H, Angermeyer MC: The WHOQOL-OLD. Psychother Psychosom Med Psychol 2006, 56(2):63-69.
- [51]Fydrich T, Sommer G, Brähler E: Fragebogen zur Sozialen Unterstützung (F-SozU). Manual. Göttingen: Hogrefe; 2007.
- [52]Dias N, Kempen GI, Todd CJ, Beyer N, Freiberger E, Piot-Ziegler C, Yardley L, Hauer K: The german version of the falls efficacy scale-international version (FES-I). Z Gerontol Geriatr 2006, 39(4):297-300.
- [53]Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, Sayer AA: A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 2011, 40(4):423-429.
- [54]Kondrup J, Allison SP, Elia M, Vellas B, Plauth M: ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003, 22(4):415-421.
- [55]Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, et al.: Overview of the MNA-Its history and challenges. J Nutr Health Aging 2006, 10(6):456-463.
- [56]Kessler J, Denzler P, Markowitsch HJ: Mini Mental Status Examination MMSE. German Version. Beltz-Verlag: Weinheim; 1990. [DT Demenz-Test: Eine Testbatterie zur Erfassung kognitiver Beeinträchtigungen im Alter]
- [57]Folstein MF, Folstein SE, McHugh PR: “Mini-mental state”. a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12(3):189-198.
- [58]Data Imput GmbH: Gebrauchsanleitung Jubiläumssonderserie BIA 2000 - S Bioelectrical Impedance Analyzer. [ http://www.data-input.de/media/pdf-deutsch/Gebrauchsanleitung_BIA_2000S.pdf webcite]
- [59]Guerra RS, Amaral TF, Marques EA, Mota J, Restivo MT: Anatomical location for waist circumference measurement in older adults: a preliminary study. Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 2012, 27(5):1554-1561.
- [60]Schroder H, Fito M, Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Lamuela-Raventos R, Ros E, Salaverria I, Fiol M, et al.: A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr 2011, 141(6):1140-1145.
- [61]Kroke A, Klipstein-Grobusch K, Voss S, Moseneder J, Thielecke F, Noack R, Boeing H: Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods. Am J Clin Nutr 1999, 70(4):439-447.
- [62]Boumendjel N, Herrmann F, Girod V, Sieber C, Rapin C-H: Refrigerator content and hospital admission in old people. Lancet 2000, 356(9229):563.
- [63]Marchart P: Anthropometrisch- und Altersbezogene Referenzwerte für die Maximalkraft und Kraftausdauer bei Kindern (ab 12 J.), Jugendlichen und Erwachsenen. Vienna: University of Vienna; 2002. [Diploma Thesis]
- [64]Washburn RA, Smith KW, Jette AM, Janney CA: The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol 1993, 46(2):153-162.
- [65]Dlugosch GE WK: Fragebogen zur Erfassung des Gesundheitsverhaltens (FEG). Frankfurt: Swets Test Services; 1995.
- [66]Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49(2):M85-M94.
- [67]Hinrichs T, Bucchi C, Brach M, Wilm S, Endres HG, Burghaus I, Trampisch HJ, Platen P: Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner’s surgery: study protocol of a single arm trial preparing an RCT [ISRCTN58562962]. BMC Geriatr 2009, 9:37. BioMed Central Full Text
- [68]Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M: Effects of different exercise interventions on risk of falls, gait ability and balance in physically frail older adults. A systematic review. Rejuvenation Res 2013, 16(2):105-114.
- [69]Sullivan DH, Roberson PK, Smith ES, Price JA, Bopp MM: Effects of muscle strength training and megestrol acetate on strength, muscle mass, and function in frail older people. J Am Geriatr Soc 2007, 55(1):20-28.
- [70]Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ: Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994, 330(25):1769-1775.
- [71]Seynnes O, Fiatarone Singh MA, Hue O, Pras P, Legros P, Bernard PL: Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. J Gerontol A Biol Sci Med Sci 2004, 59(5):503-509.
- [72]Matsuda PN, Shumway-Cook A, Ciol MA: The effects of a home-based exercise program on physical function in frail older adults. J Geriatr Phys Ther 2010, 33(2):78-84.
- [73]Clegg A, Barber S, Young J, Forster A, Iliffe S: The home-based older People’s exercise (HOPE) trial: study protocol for a randomised controlled trial. Trials 2011, 12:143. BioMed Central Full Text
- [74]Bonnefoy M, Boutitie F, Mercier C, Gueyffier F, Carre C, Guetemme G, Ravis B, Laville M, Cornu C: Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study. J Nutr Health Aging 2012, 16(4):370-377.
- [75]Gill TM, Baker DI, Gottschalk M, Gahbauer EA, Charpentier PA, de Regt PT, Wallace SJ: A prehabilitation program for physically frail community-living older persons. Arch Phys Med Rehabil 2003, 84(3):394-404.
- [76]Hinrichs T, Moschny A, Brach M, Wilm S, Klaassen-Mielke R, Trampisch M, Platen P: Effects of an exercise programme for chronically ill and mobility-restricted elderly with structured support by the general practitioner’s practice (HOMEfit) - study protocol of a randomised controlled trial. Trials 2011, 12:263. BioMed Central Full Text
- [77]Vestergaard S, Kronborg C, Puggaard L: Home-based video exercise intervention for community-dwelling frail older women: a randomized controlled trial. Aging Clin Exp Res 2008, 20(5):479-486.
- [78]Dorner TE, Rieder A, Lawrence K, Jancuska A, Gisinger C: Prevalence of obesity in a geriatric long-term care facility. JNHA 2006., 10(72)
PDF