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Han CY, Sharma Y, Yaxley A, Baldwin C, Woodman R, Miller M. Individualized Hospital to Home, Exercise-Nutrition Self-Managed Intervention for Pre-Frail and Frail Hospitalized Older Adults: The INDEPENDENCE Randomized Controlled Pilot Trial. Clin Interv Aging 2023; 18:809-825. [PMID: 37220521 PMCID: PMC10200110 DOI: 10.2147/cia.s405144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Pre-frailty and frailty in older adults are associated with poor health outcomes and increase health-care costs, and further worsening during hospitalization. This study aimed to examine the effect of an individualized hospital to home, exercise-nutrition self-managed intervention for pre-frail and frail hospitalized older adults. Patients and Methods Older adults admitted to an acute medical unit of a tertiary hospital in South Australia who were pre-frail or frail were recruited from September 2020 to June 2021, randomized to either control or intervention group and followed up at 3 and 6 months. The outcome variables were program adherence, frailty status by the Edmonton Frail Scale (EFS) score, lower extremity physical function, handgrip strength, nutritional status, cognition, mood, health-related quality of life, risk of functional decline, unplanned readmissions. Results Participants were 79.2 ±6.6 years old, 63% female, mostly frail (67%), with EFS of 8.6±1.9. Adherence to the inpatient and home visits/telehealth intervention were high (91±13% and 92±21%, respectively). Intention-to-treat analysis using linear regression models showed that participants in the intervention group had significantly greater reduction in EFS at 3 (-3.0; 95% CI: -4.8 to -3.0) and 6 months (-2.5; 95% CI: -3.8 to -1.0, P<0.001 for both) compared to the control group; particularly the functional performance component. There were also improvements in overall Short Physical Performance Battery score at 3 (4.0; 95% CI: 1.3 to 6.6) and 6 months (3.9; 95% CI: 1.0 to 6.9, P<0.05 for both), mini-mental state examination (2.6; 95% 0.3-4.8, P=0.029) at 3 months and handgrip strength (3.7; 95% CI: 0.2-7.1, P=0.039) and Geriatric Depression Scale, at 6 months (-2.2; 95% CI: -4.1 to -0.30, P=0.026) in the intervention group as compared to control. Conclusion This study provided evidence of acceptability to a patient self-managed exercise-nutrition program that may benefit and alleviate pre-frailty and frailty in hospitalised older adults.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of General Medicine, Flinders Medical Centre, Adelaide, SA, Australia
| | - Alison Yaxley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients. Geriatrics (Basel) 2022; 7:geriatrics7050095. [PMID: 36136804 PMCID: PMC9498394 DOI: 10.3390/geriatrics7050095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
In acutely hospitalized older patients (≥65 years), the association between mild cognitive impairment (MCI) and malnutrition is poorly described. We hypothesized that (1) MCI is associated with nutritional status on admission and after discharge; (2) MCI is associated with a change in nutritional status; and (3) a potential association is partly explained by frailty, comorbidity, medication use, and age. We combined data from a randomized controlled trial (control group data) and a prospective cohort study (ClinicalTrials.gov: NCT01964482 and NCT03052192). Nutritional status was assessed on admission and follow-up using the Mini Nutritional Assessment—Short Form. MCI or intact cognition (noMCI) was classified by three cognitive performance tests at follow-up. Data on frailty, comorbidity, medication use, and age were drawn from patient journals. MCI (n = 42) compared to noMCI (n = 47) was associated with poorer nutritional status with an average difference of −1.29 points (CI: −2.30; −0.28) on admission and −1.64 points (CI: −2.57; −0.70) at 4-week follow-up. Only age influenced the estimates of −0.85 (CI: −1.86; 0.17) and −1.29 (CI: −2.25; −0.34), respectively. In acutely hospitalized older patients, there is an association between MCI and poorer nutritional status upon admission and four weeks after discharge. The association is partly explained by higher age.
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Jawad BN, Petersen J, Andersen O, Pedersen MM. Variations in physical activity and sedentary behavior during and after hospitalization in acutely admitted older medical patients: a longitudinal study. BMC Geriatr 2022; 22:209. [PMID: 35291952 PMCID: PMC8925078 DOI: 10.1186/s12877-022-02917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inactivity is frequent among older patients during hospitalization. It is unknown how patients' daily activity pattern (diurnal profile) vary between hospitalization and after discharge. This study aims to describe and compare the distribution of physical activity and sedentary behavior in acutely hospitalized older patients during hospitalization and after discharge. METHODS We included data on 80 patients (+65 years) admitted with acute medical illness from the STAND-Cph trial. Physical activity and sedentary behavior were measured as daily number of steps, uptime (walking/standing) and sedentary behavior (lying/sitting) with an activity monitor (activPAL3, PAL Technologies Ltd). The patients wore the monitor for three periods of one week: during hospitalization, after discharge, and four weeks after discharge. RESULTS The patients' median age was 80 years [IQR: 75;88], 68% were female and the median De Morton Mobility Index (DEMMI) was 57 [IQR: 48;67]. The daily median uptime was 1.7 h [IQR: 1;2.8] during hospitalization, 4.0 h [IQR: 2.7;5.4] after discharge and 4.0 h [IQR: 2.8;5.8] four weeks after discharge. The daily median number of steps was 728 [IQR: 176;2089], 2207 [IQR: 1433;3148], and 2622 [IQR: 1714;3865], respectively, and median daily sedentary behavior was 21.4 h (IQR: 20.7;22.4), 19.5 h (IQR: 18.1;21.0) and 19.6 h (IQR: 18.0;20.8), respectively. During hospitalization, a small activity peak was observed between 9-11 AM without any notable variation after. At discharge and four weeks after discharge, a peak in physical activity was seen between 9-12 AM and at 5 PM. CONCLUSION Older hospitalized patients spend most of their time being sedentary with their highest activity between 9-11 AM. Daily activity doubles after discharge with one extra peak in the afternoon. Daily routines might be disrupted, and older patients have the potential to be more physically active during hospitalization. Interventions that encourage physical activity during hospitalization are warranted.
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Affiliation(s)
- Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark. .,The Emergency Department, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Nørre Allé 20, DK-2200, Copenhagen-N, Denmark.
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark.,The Emergency Department, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Nørre Allé 20, DK-2200, Copenhagen-N, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Nørre Allé 20, DK-2200, Copenhagen-N, Denmark
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Tobberup R, Carus A, Rasmussen HH, Falkmer UG, Jorgensen MG, Schmidt EB, Jensen NA, Mark EB, Delekta AM, Antoniussen CS, Bøgsted M, Holst M. Feasibility of a multimodal intervention on malnutrition in patients with lung cancer during primary anti-neoplastic treatment. Clin Nutr 2020; 40:525-533. [PMID: 32600857 DOI: 10.1016/j.clnu.2020.05.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Wasting of body mass and skeletal muscle frequently develops in patients with cancer and is associated with impaired functional ability and poor clinical outcome and quality of life. This study aimed to evaluate the feasibility and explore the effect of a multimodal intervention targeting nutritional status in patients with non-small cell lung cancer receiving primary anti-neoplastic treatment. Additionally, predictive and prognostic factors of gaining skeletal muscle were explored. METHODS This was a single-centre multimodal intervention trial using a historical control group. The multimodal intervention involved fish oil intake (2 g of eicosapentaenoic acid or docosahexaenoic acid daily), regular dietary counselling and unsupervised physical exercise twice weekly during the first three cycles of primary anti-neoplastic treatment. Feasibility was assessed through recruitment rate, completion rate and compliance rate with the intervention. Differences in skeletal muscle, body weight, and physical function between the intervention and historical control groups were analysed. Factors contributing to increased skeletal muscle were explored using univariate and multivariate ordinal logistic regression analyses. RESULTS The recruitment and completion rates were 0.48 (n = 59/123) and 0.80 (n = 46/59), respectively. The overall compliance rate with all five individual interventions was 0.60 (n = 28/47). The individual compliance rates were 0.81 (n = 38/47) with fish oil intake, 0.94 (n = 44/47) with energy intake, 0.98 (n = 46/47) with protein intake, 0.51 (n = 24/47) with resistance exercise and 0.57 (n = 27/47) with aerobic exercise. No mean differences in skeletal muscle, body weight, or physical function were found between the intervention and control groups. However, a larger proportion of patients in the intervention group gained skeletal muscle (p < 0.02). The identified contributing factors of muscle gain were weight gain (OR, 1.3; p = 0.01), adherence to treatment plan (OR, 4.6; p = 0.02), stable/partial response (OR, 3.3; p = 0.04) and compliance to the intervention (OR, 7.4; p = 0.01). Age, sex, tumour stage, performance status, treatment type and baseline cachexia did not predict muscle gain. CONCLUSION This three-dimensional intervention in patients with lung cancer undergoing primary anti-neoplastic treatment was feasible and increased the proportion of patients gaining skeletal muscle. Dietary counselling and fish oil use were useful strategies. The motivation for conducting unsupervised physical intervention was low. Clinical trials.gov identifier: NCT04161794.
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Affiliation(s)
- Randi Tobberup
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 5, 9000, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Andreas Carus
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 5, 9000, Aalborg, Denmark; Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Henrik H Rasmussen
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 5, 9000, Aalborg, Denmark
| | - Ursula G Falkmer
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 5, 9000, Aalborg, Denmark; Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Martin G Jorgensen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Erik B Schmidt
- Department of Cardiology, Aalborg AF Study Group, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
| | - Nikolaj A Jensen
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Esben B Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Agnieszka M Delekta
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | | | - Martin Bøgsted
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 5, 9000, Aalborg, Denmark; Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Mette Holst
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 5, 9000, Aalborg, Denmark
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Pedersen MM, Petersen J, Beyer N, Larsen HGJ, Jensen PS, Andersen O, Bandholm T. A randomized controlled trial of the effect of supervised progressive cross-continuum strength training and protein supplementation in older medical patients: the STAND-Cph trial. Trials 2019; 20:655. [PMID: 31779693 PMCID: PMC6883554 DOI: 10.1186/s13063-019-3720-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/13/2019] [Indexed: 01/03/2023] Open
Abstract
Background During hospitalization, older adults (+ 65 years) are inactive, which puts them at risk of functional decline and loss of independence. Systematic strength training can prevent loss of functional performance and combining strength training with protein supplementation may enhance the response in muscle mass and strength. However, we lack knowledge about the effect of strength training commenced during hospitalization and continued after discharge in older medical patients. This assessor-blinded, randomized study investigated the effect of a simple, supervised strength training program for the lower extremities, combined with post-training protein supplementation during hospitalization and in the home setting for 4 weeks after discharge, on the effect on change in mobility in older medical patients. Methods Older medical patients (≥ 65 years) admitted acutely from their home to the Emergency Department were randomized to either standard care or supervised progressive strength training and an oral protein supplement during hospitalization and at home 3 days/week for 4 weeks after discharge. The primary outcome was between-group difference in change in mobility from baseline to 4 weeks after discharge assessed by the De Morton Mobility Index, which assesses bed mobility, chair mobility, static and dynamic balance, and walking. Secondary outcomes were 24-h mobility, lower extremity strength, gait speed, grip strength and activities of daily living. Results Eighty-five patients were randomized to an intervention group (N = 43) or a control group (N = 42). In the intervention group, 43% were highly compliant with the intervention. Our intention-to-treat analysis revealed no between-group difference in mobility (mean difference in change from baseline to 4 weeks, − 4.17 (95% CI − 11.09; 2.74; p = 0.24) nor in any of the secondary outcomes. The per-protocol analysis showed that the daily number of steps taken increased significantly more in the intervention group compared to the control group (mean difference in change from baseline to 4 weeks, 1033.4 steps (95% CI 4.1; 2062.7), p = 0.049, adjusted for mobility at baseline and length of stay; 1032.8 steps (95% CI 3.6; 2061.9), p = 0.049, adjusted for mobility at baseline, length of stay, and steps at baseline). Conclusions Simple supervised strength training for the lower extremities, combined with protein supplementation initiated during hospitalization and continued at home for 4 weeks after discharge was not superior to usual care in the effect on change in mobility at 4 weeks in older medical patients. For the secondary outcome, daily number of steps, high compliance with the intervention resulted in a greater daily number of steps. Less than half of the patients were compliant with the intervention indicating that a simpler intervention might be needed. Trial registration ClinicalTrials.gov, NCT01964482. Registered on 14 October 2013. Trial protocol PubMed ID (PMID), 27039381.
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Affiliation(s)
- Mette Merete Pedersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 Entrance B, 2nd floor, 1014, Copenhagen K, Denmark.,Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen N, Denmark
| | - Nina Beyer
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen N, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Helle Gybel-Juul Larsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Pia Søe Jensen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.,The Emergency Department, Copenhagen University Hospital, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Thomas Bandholm
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Physical- and Occupational Therapy, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark
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