Efficacy of multidomain interventions to improve physical frailty, depression and cognition: data from cluster-randomized controlled trials

Liang-Kung Chen, An-Chun Hwang, Wei-Ju Lee, Li-Ning Peng, Ming-Hsien Lin, David L Neil, Shu-Fang Shih, Ching-Hui Loh, Shu-Ti Chiou, Taiwan Health Promotion Intervention Study for Elders research group, Liang-Kung Chen, An-Chun Hwang, Wei-Ju Lee, Li-Ning Peng, Ming-Hsien Lin, David L Neil, Shu-Fang Shih, Ching-Hui Loh, Shu-Ti Chiou, Taiwan Health Promotion Intervention Study for Elders research group

Abstract

Background: Frailty is the pre-eminent exigency of aging. Although frailty-related impairments are preventable, and multidomain interventions appear more effective than unimodal ones, the optimal components remain uncertain.

Methods: We devised multidomain interventions against physical and cognitive decline among prefrail/frail community-dwelling ≥65-year-olds and evaluated these in complementary cluster-randomized trials of efficacy and participant empowerment. The Efficacy Study compared ~3-monthly telephone consultations vs. 16, 2 h sessions/year comprising communally partaken physical and cognitive training plus nutrition and disease education; the Empowerment Study compared the standard Efficacy Study multidomain intervention (Sessions 1-10) vs. an enhanced version redesigned to empower and motivate individual participants. Changes from baseline in physical, functional, and cognitive performance were measured after 6 and 12 months in the Efficacy Study and after 6 months in the Empowerment Study, with post-intervention follow-up at 9 months. Primary outcomes are as follows: Cardiovascular Health Study frailty score; gait speed; handgrip strength; and Montreal Cognitive Assessment (MoCA). Secondary outcomes are as follows: instrumental activities of daily living; metabolic equivalent of task (MET); depressed mood (Geriatric Depression Scale-5 ≥2); and malnutrition (Mini-Nutritional Assessment short-form ≤11). Intervention effects were analyzed using a generalized linear mixed model.

Results: Efficacy Study participants (n = 1082, 40 clusters) were 75.1 ± 6.3 years old, 68.7% women, and 64.7% prefrail/frail; analytic clusters: 19 intervention (410/549 completed) vs. 21 control (375/533 completed). Empowerment Study participants (n = 440, 14 clusters) were 75.9 ± 7.1 years old, 83.6% women, and 56.7% prefrail/frail; analytic clusters: seven intervention (209/230 completed) vs. seven control (189/210 completed). The standard and enhanced multidomain interventions both reduced frailty and significantly improved aspects of physical, functional, and cognitive performance, especially among ≥75-year-olds. Standard multidomain intervention decreased depression [odds ratio 0.56, 95% confidence interval (CI) 0.32, 0.99] and malnutrition (odds ratio 0.45, 95% CI 0.26, 0.78) by 12 months and improved concentration at Months 6 (0.23, 95% CI 0.04, 0.42) and 12 (0.46, 95% CI 0.22, 0.70). Participant empowerment augmented activity (4.67 MET/h, 95% CI 1.64, 7.69) and gait speed (0.06 m/s, 95% CI 0.00, 0.11) at 6 months, with sustained improvements in delayed recall (0.63, 95% CI 0.20, 1.06) and MoCA performance (1.29, 95% CI 0.54, 2.03), and less prevalent malnutrition (odds ratio 0.39, 95% CI 0.18, 0.84), 3 months after the intervention ceased.

Conclusions: Pragmatic multidomain intervention can diminish physical frailty, malnutrition, and depression and enhance cognitive performance among community-dwelling elders, especially ≥75-year-olds; this might supplement healthy aging policies, probably more effectively if participants are empowered.

Keywords: Cognitive; Community; Elder empowerment; Healthy aging; Malnutrition; Multidomain intervention; Outcome; Physical frailty.

Conflict of interest statement

L.‐K.C., A.‐C.H., W.‐J.L., L.‐N.P., M.‐H.L., S.‐F.S., C.‐H.L., and S.‐T.C. declare no conflicts of interest. D.L.N. is a professional medical writer employed at time of writing by Full Universe Integrated Marketing Ltd., Taiwan.

© 2020 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Figures

Figure 1
Figure 1
Efficacy and Empowerment Studies: participant selection, randomization, and disposition. ADL, activities of daily living.
Figure 2
Figure 2
Mean changes from baseline performance. (A) Physical domains; (B) functional domains; and (C) cognitive domains. CHS, Cardiovascular Health Study; MET, metabolic equivalent of task; IADL, instrumental activities of daily living; MoCAadj, Montreal Cognitive Assessment (adjusted cut‐off). *P < 0.05; **P < 0.01; ***P < 0.001; vertical bars indicate standard error.
Figure 3
Figure 3
Intervention effects on physical and functional performance. (A) Efficacy Study; (B) Empowerment Study. CHS, Cardiovascular Health Study; MET, metabolic equivalent of task. Horizontal bars indicate 95% confidence intervals at 6 months (blue) and 12 or 9 months (orange).
Figure 4
Figure 4
Intervention effects on cognitive performance. (A) Efficacy Study; (B) Empowerment Study. Horizontal bars indicate 95% confidence intervals at 6 months (blue) and 12 or 9 months (orange).

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