TY - JOUR
T1 - Integrated care for geriatric frailty and sarcopenia
T2 - a randomized control trial
AU - Chan, Ding Cheng Derrick
AU - Tsou, Hsiao Hui
AU - Chang, Chirn Bin
AU - Yang, Rong Sen
AU - Tsauo, Jau Yih
AU - Chen, Ching Yu
AU - Hsiao, Chin Fu
AU - Hsu, Ya Ting
AU - Chen, Chia Hui
AU - Chang, Shu Fang
AU - Hsiung, Chao Agnes
AU - Kuo, Ken N.
N1 - Funding Information:
1Department of Geriatrics and Gerontology, and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Superintendent Office, National Taiwan University Hospital Chu-Tung Branch, Hsin-Chu County, Taiwan; 3Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; 4Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan; 5Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; 6Department of Internal Medicine, National Taiwan University Hospital Chu-Tung Branch, Hsin-Chu County, Taiwan; 7Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; 8School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; 9Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; 10Division of Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Taipei, Taiwan; 11Division of Clinical Trial Statistics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; 12Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 13Division of Mental Health and Addiction Medicine, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; 14Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 15Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan; 16Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
Funding Information:
Three-hundred and twenty-three subjects signed the written informed consents and completed first-stage screening with the Chinese Canadian Study of Health and Aging Clinical Frailty Scale (CCSHA_CFS) in-person interview version, modified from the previous Telephone Version (TV)9,10 (Figure 1) patient outcomes. (Figure 1). The study was approved in 2009 by the Research Ethics Committee of the National Health Research Institutes (NHRI), Zhunan, Taiwan (Protocol ID: EC0970301, ClinicalTrials.gov: NCT00718432).
Publisher Copyright:
© 2016 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders
PY - 2017/2
Y1 - 2017/2
N2 - Background: Exercise, nutrition, and psychological interventions may all have positive impacts on frailty and sarcopenia. However, it is not known whether an integrated care programme with all three components can be beneficial and the intensity of such programme is also not certain. In this study, we aim to determine the effectiveness of two levels of integrated care on frailty and sarcopenia. Methods: A randomized control trial was conducted at two community hospitals in Taiwan. Older adults (65–79 years of age, N = 289) who scored ≥1 on the Cardiovascular Health Study Phenotypic Classification of Frailty (CHS_PCF) were enrolled in the trial. Low-level care (LLC) participants received a 2 h education course on frailty, sarcopenia, coping strategy, nutrition, and demonstration of study exercise programme. Educational multimedia material was distributed as reference for home practice with bi-monthly telephone follow-ups on adherences. High-level care (HLC) participants, in addition to LLC instructions, received six sessions of on-site problem solving therapy and 48 exercise sessions within 6 months. Brief nutrition consultation was also provided during the exercise sessions. Primary outcome was improvement of the CHS_PCF by at least one category (from pre-frail to robust, or from frail to pre-frail or robust) from baseline. Secondary outcomes included changes of individual frailty, and sarcopenia indicators. Assessments were done at 3, 6, and 12 months by trained research assistants blinded to randomization status. Intention-to-treat analysis was applied. Results: Mean age was 71.6 ± 4.3 years, with 53% females. For the entire cohort, improvement of primary outcome was 35% at 3 months, increased to 40% at 6 months, and remained stable at 39% at 12 months. Improvement rates were similar in both groups. Compared with the LLC group, HLC participants had greater improvements in the following indices: energy expenditure of walking, 5 m walking time, dominant hand grip strength, timed-up-and-go-test, and one-leg-stand time — mainly at 6 and 12 month assessments. Conclusions: The 6 month integrated care improved frailty and sarcopenia status among community-dwelling elders, with high-intensity training yielding greater improvements. Low-level care could be promoted as a basic intervention, while HLC could be reserved for those at high risk and with high motivation.
AB - Background: Exercise, nutrition, and psychological interventions may all have positive impacts on frailty and sarcopenia. However, it is not known whether an integrated care programme with all three components can be beneficial and the intensity of such programme is also not certain. In this study, we aim to determine the effectiveness of two levels of integrated care on frailty and sarcopenia. Methods: A randomized control trial was conducted at two community hospitals in Taiwan. Older adults (65–79 years of age, N = 289) who scored ≥1 on the Cardiovascular Health Study Phenotypic Classification of Frailty (CHS_PCF) were enrolled in the trial. Low-level care (LLC) participants received a 2 h education course on frailty, sarcopenia, coping strategy, nutrition, and demonstration of study exercise programme. Educational multimedia material was distributed as reference for home practice with bi-monthly telephone follow-ups on adherences. High-level care (HLC) participants, in addition to LLC instructions, received six sessions of on-site problem solving therapy and 48 exercise sessions within 6 months. Brief nutrition consultation was also provided during the exercise sessions. Primary outcome was improvement of the CHS_PCF by at least one category (from pre-frail to robust, or from frail to pre-frail or robust) from baseline. Secondary outcomes included changes of individual frailty, and sarcopenia indicators. Assessments were done at 3, 6, and 12 months by trained research assistants blinded to randomization status. Intention-to-treat analysis was applied. Results: Mean age was 71.6 ± 4.3 years, with 53% females. For the entire cohort, improvement of primary outcome was 35% at 3 months, increased to 40% at 6 months, and remained stable at 39% at 12 months. Improvement rates were similar in both groups. Compared with the LLC group, HLC participants had greater improvements in the following indices: energy expenditure of walking, 5 m walking time, dominant hand grip strength, timed-up-and-go-test, and one-leg-stand time — mainly at 6 and 12 month assessments. Conclusions: The 6 month integrated care improved frailty and sarcopenia status among community-dwelling elders, with high-intensity training yielding greater improvements. Low-level care could be promoted as a basic intervention, while HLC could be reserved for those at high risk and with high motivation.
KW - Aged
KW - Effectiveness
KW - Frailty
KW - Randomized control trial
KW - Sarcopenia
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U2 - 10.1002/jcsm.12132
DO - 10.1002/jcsm.12132
M3 - Article
C2 - 27897406
AN - SCOPUS:84997701960
SN - 2190-5991
VL - 8
SP - 78
EP - 88
JO - Journal of Cachexia, Sarcopenia and Muscle
JF - Journal of Cachexia, Sarcopenia and Muscle
IS - 1
ER -