The effectiveness of nutrition interventions in improving frailty and its associated constructs related to malnutrition and functional decline among community‐dwelling older adults: A systematic review

• Published in: Journal of human nutrition and dietetics 2022-06, Vol.35 (3), p.566-582
• Main Authors: Khor, Phay Yean, Vearing, Rebecca M., Charlton, Karen E.
• Format: Article
• Language: English
• Subjects: Adults; Clinical trials; Frailty; functional ability; Guidelines; Literature reviews; Malnutrition; Nutrition; Nutritional status; Older people; Performance evaluation; Proteins; Risk analysis; Risk factors; Risk management; Sarcopenia; systematic literature review; Systematic review
• ISSN: 0952-3871; 1365-277X
• DOI: 10.1111/jhn.12943

Background The present study aimed to evaluate the effectiveness of nutrition interventions on frailty and factors related to frailty, including malnutrition, sarcopenia and functional ability, among community dwelling older adults. A secondary aim was to synthesise current clinical guidelines for the identification and management of frailty, and then identify whether they aligned with the findings of the literature review. Methods A systematic literature review was undertaken using four electronic databases to identify randomised controlled clinical trials that assessed the effect of nutrition interventions on frailty and outcomes related to frailty in community‐dwelling older adults (PROSPERO #CRD42017069094). The quality of the included studies was appraised. A rapid review was conducted using the Google Scholar database to identify existing clinical recommendations relating to the second aim. Results The search strategy identified 13 studies. Multifactorial interventions with nutritional education and protein‐energy supplementation improved frailty stratus and physical performance in 75% and 58% of studies, respectively. Weight and nutritional status improved in 80% of studies that used oral nutritional support. The recommended process for clinical management of frailty involves screening, followed by full assessment using validated instruments and the development of a comprehensive management plan with a multidisciplinary team. Conclusions Multifactorial interventions were found to be more effective than nutrition intervention alone for improving frailty and physical performance. Protein‐energy supplementation tended to be effective only in malnourished older adults. The results were inconclusive for the use of micronutrient supplementation for frailty and outcomes related to frailty. Existing clinical guidelines are aligned with the evidence recommending comprehensive interventions to improve frailty. Study Highlights Frailty and malnutrition have similar risk factors and management strategies. A systematic literature review identified 13 studies on the effectiveness of nutrition interventions to improve frailty and physical performance in community dwelling older adults. Nutrition interventions need to be multifactorial, including exercise, psychological intervention, social skills or polypharmacy reduction, to be effective in improving frailty.