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Frailty, body composition and nutritional status in non-institutionalised
elderly
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ORIGINAL
ARTICLE
Frailty,
body
composition
and
nutritional
status
in
non-institutionalised
elderly
夽
Leonel
São
Romão
Preto
a,∗,
Maria
do
Carmo
Dias
Conceic
¸ão
b,
Telma
Martins
Figueiredo
a,
Maria
Augusta
Pereira
Mata
a,
Pedro
Miguel
Barreira
Preto
c,
Ester
Mateo
Aguilar
daDepartamentodeEnfermagem,EscolaSuperiordeSaúde,InstitutoPolitécnicodeBraganc¸a,Braganc¸a,Portugal bSantaCasadaMisericórdiadeMurc¸a,VilaReal,Portugal
cServic¸odeOrtotraumatologia,UnidadeLocaldeSaúdedoNordeste,Braganc¸a,Portugal dDepartamentodeEnfermería,UniversidaddeAlmería,Almería,Spain
Received28March2017;accepted21June2017
Availableonline5September2017
KEYWORDS Ageing; Frailelderly; Bodycomposition; Nutritionalstatus Abstract
Objective: Frailtyisaclinicalsyndromecharacterised,amongothersigns,byinvoluntaryweight
lossanddecreasedmusclestrength.Theaimofthisstudywastoanalyseassociationsbetween frailty,bodycompositionandnutritionalstatusinnon-institutionalisedelderlypeopleinthe municipalityofAlfândega(Braganza-Portugal).
Method: Observational,prevalenceandassociationstudyinvolving220elderly(mean75.8±6.8
yearsofage;68.8%women).FrailtywasassessedaccordingtoFriedcriteria,bodycomposition bybioelectricalimpedanceanalysisandnutritionalstatususingtheMiniNutritionalAssessment Short-Form.
Results:Theprevalenceoffrailtywas23.6%.Frailparticipantshad,onaverage,lowertotal
musclemassandlower segmental musclemass(armsandlegs)thanpre-frail andnon-frail (p<0.001).Fromtheelderlyatriskofmalnutritionorundernourished (n=24),themajority (n=13)hadfrailtysyndrome.Itwasobservedthat41.2%oftheelderlywithlowweightwere frail.Thissyndromeprevailedonlyin17.1%oftheeutrophicpersons,increasingagainto22.4% intheoverweightgroup(p<0.001).
Conclusion: Thephenotypicprofileoffrailelderlywascharacterisedby lowermusclemass.
Theresultsofourstudysuggestthatbothunderweightandoverweightmaybeassociatedwith frailty.Thereistheneedtopreventandmanagefrailty,notonlytakingintoaccountpossible
DOIoforiginalarticle:http://dx.doi.org/10.1016/j.enfcli.2017.06.004
夽 Pleasecitethisarticleas:SãoRomãoPretoL,DiasConceic¸ãoMC,FigueiredoTM,PereiraMataMA,BarreiraPretoPM,MateoAguilarE.
Fragilidad,composicióncorporalyestadonutricionalenancianosnoinstitucionalizados.EnfermClin.2017;27:339---345.
∗Correspondingauthor.
E-mailaddress:leonelpreto@ipb.pt(L.SãoRomãoPreto).
340 L.SãoRomãoPretoetal. treatablemedicalcauses,butalsobyinterveninginimportantpillars,suchasphysicalactivity, dietaryandnutritionalproblems.
©2017PublishedbyElsevierEspa˜na,S.L.U.
PALABRASCLAVE Envejecimiento; Ancianofrágil; Composición corporal; Estadonutricional
Fragilidad,composicióncorporalyestadonutricionalenancianosno institucionalizados
Resumen
Objetivo:Lafragilidadesunsíndromeclínicocaracterizado,entreotrossignos,porlapérdida
involuntariade pesoy fuerzamuscular disminuida.Elobjetivode esteestudiofueanalizar asociacionesentrefragilidad,composicióncorporalyestadonutricionalenancianosno insti-tucionalizadosdelmunicipiodeAlfândega(Braganza-Portugal).
Método: Estudioobservacional,deprevalenciayasociacióncruzadaenelqueparticiparon220
ancianos(edadmediade75,8±6,8a˜nos;68,8%mujeres).Lafragilidadfueevaluadasegúnel fenotipodeFried,lacomposicióncorporalporimpedanciabioeléctricayelestadonutricional medianteelMiniNutritionalAssessmentShort-Form.
Resultados: Laprevalenciadefragilidadfuedel23,6%.Losparticipantesfrágilespresentaban,
enpromedio,menormasamusculartotalymenormasamuscularporsegmentos(brazosy pier-nas)quelosprefrágilesynofrágiles(p<0,001).Deaquellosancianosenriesgodedesnutrición odesnutridos(n=24),lamayoría(n=13)presentabansíndromedefragilidad.Seobservóque el41,2%delosancianosconbajopesoeranfrágiles.Dicho síndromeprevaleciótansoloen el17,1%delaspersonaseutróficas,aumentandodenuevoal22,4%enelgrupoconsobrepeso (p<0,001).
Conclusión:Elperfilfenotípicodelosancianosfrágilessecaracterizópormenormasamuscular.
Losresultadosdenuestroestudiosugierenquetantoelbajopesocomoelsobrepesopodrán conducirasituacionesdefragilidad.Esfundamentalprevenirygestionarlafragilidad,nosolo teniendoencuentalasposiblescausasmédicastratables,sinotambiéninterviniendoenpilares importantes,comolaactividadfísicaylosproblemasdietéticosynutricionales.
©2017PublicadoporElsevierEspa˜na,S.L.U.
What
is
known?
Multiple organic and systemic changes taking place duringtheageingprocessarereflectedinbody compo-sitionandnutritionalstatusoftheelderly.
With regards to body composition, studies report alower muscle andbone mass which inturn affects muscle strength and increases functional deteriora-tion.Moreover,nutritionalstatusaffectsthehealthand qualityoflifeofelderlypeople.
Bothsarcopeniaandmalnutritionmayleadtofrailty in the elderly and are commonly found problems in thegeriatricpopulation.Inaccordancewiththe phe-notypedevelopedbyLindaFried,frailtyintheelderly is a clinical syndrome which is identifiable by the presenceofatleast3ofthefollowingcriteria: involun-taryweightloss,fatigue/exhaustion,reducedphysical activity, slowness in walking and decreased muscle strength.
Since thephenotypemodel assessesclinical crite-ria which is closely linkedwith sarcopenia, research incorporatingclarifyingvariablesofthemodelitselfis necessary,togetherwiththosegoverningbody compo-sitionandnutritionalstatus.
What
does
this
paper
contribute?
This research study is a contribution to previously provided evidence of aspects which have not been investigatedin depth before,suchasthe prevalence offrailtyinthePortugueseelderlyandespeciallythe results of the various components of body composi-tion (muscle mass, bone mass, fat and water in the body)differentiatingbetween non-frail,pre-frailand frailelderlypeople.
Studyfindings outlinetheneed forpreventingand managingfrailty, notjusttakingintoaccountchronic illnesses,butalsoassessingthepromotionofphysical activityanddietaryandnutritionalproblems.
Togetherwiththerestoftheevidence,resultsmay contribute tothedesign of interventional andactive ageingprogrammesfortheelderly.
Introduction
Frailtyisageriatricsyndromecharacterisedbythelossof reserves and energy in many organs and systems, which havelosttheirhomeostaticcapacitytodealwiththe stress-fulevents ofeverydaylife.1Althoughthereisnostandard
hypothesisthatthenegativeenergybalanceresultingfrom thisstate, is observablefroma phenotypewhichincludes acombination of signsandsymptomssuchasweightloss, fatigue, reduced physical activity, reduction in walking speedandmuscleweakness.2,3
In general it is accepted that frailty is a clinical syn-dromewhichisdifferentfromfunctionalinabilityandwhich increasestheriskofadverseevents,suchasfalls,functional impairmentorinstitutionalisation.Consensushasitthatits impactmaybereversedorattenuatedthroughappropriate interventionandthatearlyrecognitionisessentialfor the elderlyperson’shealth.4Thereisevidencethatthefrailty
syndromeis morecommoninwomen, increaseswithage, with the presence of comorbiditites and polypharmacy,3
itsprevalencein Spainrangesbetween 8.5%and20.4%,5,6
similartothatreportedinother countriesinthesouthof Europe, such as France (15.0%), Greece (14.7%) or Italy (27.3%).7
Although during recent years evidence regarding the frailty syndrome has risen considerably, there are no known cohort studies in Portugal, providing us with pre-cise evidence as to frequency. Follow-up studies of frail populations and studies which evaluate intervention pro-grammesarealsoinfrequentin internationalliterature.1,3
Furthermore,sincethephenotypemodelassessesphysical issues highly linkedwith sarcopenia,2 thereis a need for
moreresearchstudiestoincorporatevariableswhichclarify themodelitself,suchasbodycompositionandnutritional status.
Itisknownthatduringtheageingprocesschangesinbody compositionoccurwhichaffectautonomyandhowthebody functions,8andthatrehabilitationandphysicalexercise
pro-grammes improve functional apptitude.9 From the fourth
decadeoflifeonwards,musclemass(MM)beginstodecline, especiallyinsedentarypeople.ThereductioninMMis usu-allyreplacedbyanincreaseinfat,whichisreflectedinthe bodymassindex(BMI).Thisnormallyrisesupto70---75years ofage,andthendrops.10Bonemineraldensityincreasesup
tothethird decade oflife, afterwhich itis progressively decreases. Osteopenia is a process which affects women morebutfrom70yearsonwards,bonelossincreasesequally inbothmenandwomen.11Bodywaterisanessential
nutri-entinalllifestages.Itprogressivelydecreasesinoldageand inthemostelderlythisreductionis associatedwithother environmentalandhealth variablesandmay leadto elec-trolyteimbalances,whichisamajorcauseofhospitalisation oftheelderly.
Basedonevidence,wemayinferthatagoodnutritional stateandregularphysicalactivity,contributetothe mainte-nanceofaneuromuscleandappropriatecognitivebalance, preventweightlossandthereductionofmusclemassand strength,thedeterminingcomponentsoffrailty.12
Inthelightofalloftheaboveweconductedastudy,the mainpurposeofwhichwastoanalysepossibleassociations between frailty, body composition and nutritional status in non-institutionalisedelderly people.Specificobjectives wereasfollows:(1)characterisetheparticipantsin accor-dance withsocio-demographic variables;(2) estimate the prevalenceoffrailty;(3)comparetheparametersofbody compositionaccordingtothedifferentlevelsoffrailty;(4) assessnutritionalstatusanditsassociationwithfrailty.
Method
Toachievetheobjectivesanobservational,prevalenceand associationcrossstudywasdesigned,whichwasconducted in the municipality of Alfândela (province of Braganza-Portugal).According tothe latest census,thiscommunity had1660inhabitantsover65yearsofage,distributedinto12 towns.Simple andproportionalrandomsampled selection wasmade, with regard to the proportion of elderly peo-pleineach town.Confidencelevelwas95%,sample error 5%andpopulationhomogeneity80/20.Exclusioncriteriaof the sample were the inability to walk independently and thepresenceofseriouscognitiveimpairment,assessedby theShortPortableMentalStatusQuestionnaire.13Thefinal
samplecomprised220elderlypeople.
Datawascollectedusingasocio-demographicandclinical questionnairewithconsiderationofthefollowingvariables: gender,maritalstatus(single,married,divorced/separated, andwidowed);age,cohabitation(livesalone,liveswiththe family);self-perceivedhealth(verygood,good,OK,bad); BMI;bodycomposition,nutritionalstatusandfrailty.
BodycompositionwasanalysedusingtheTanitaBC-545 bioelectricalimpedenceanalysisscale.Analysesweremade duringthemorning,whilstfasting,andwithanempty blad-der.Staturewasassessedusingastadiometerand forBMI classification, Lipschitz recommended cut off points and categoriesforelderlypeoplewerefollowed14:underweight
(BMI<22kg/m2), eutrophy (BMI 22---27kg/m2) and obesity (BMI>27kg/m2).
NutritionalstatuswasassessedusingtheMiniNutritional AssessmentShort-Form(MNA-SF).Thistoolisrecommended bytheEuropeanSocietyofClinicalNutritionandMetabolism forevaluatingtheriskofmalnutritioninelderlypeopleand itsdiagnostic capacityhas been well documentedin pre-viousstudies.15 The MNA-SFis a simple,non invasivetool
which has been validated in several countries, including Portugal.16Thetooldeterminesthenutritionalstatusbased
on8 scorable items,and thefinal summaryof whichmay reachamaximumof14points.Screeningvaluesbetween12 and14pointsindicateanormalnutritionalstatus,between 8and11 indicateariskofmalnutritionandscoresof 7or underindicatemalnutrition.
Frailtywasassessedaccording tothefrailty phenotype proposedbyLindaFried.2 According tothisreferencethe
following criteriawere assessed:(1) unintentional weight lossover4.5kgorabove5%ofbodymassoverthelastyear; (2) self-report on fatigue/exhaustion; (3) reduced physi-calactivity;(4)lowwalkingspeed;(5)reductionofmuscle strength.Theelderlywhometthreeormorecriteriawere classifiedasfrail,inthepresenceofoneortwoaspre-frail andintheabsenceofcriteriaasnotfrailorrobust.
Unintentional weightloss of over 4.5kg or 5% of body weightwasassessed comparingtheresultobtained inthe balanceofbodycompositionwiththatstatedbytheperson thepreviousyear.2
Fatigue/exhaustionwasevaluatedthroughtwoquestions ontheCentreforEpidemiologicStudiesDepressionScale17
questionnaire.Thisquestionnaireisoftenusedtomeasure depressivesymptomology andinparticular thisphenotype criteria,2 with two specific questions about the previous
342 L.SãoRomãoPretoetal. and‘‘didyoufeelthatyoudidnotwanttodoanything?’’
In keeping withrecommended methodology,2 fatigue was
presentwhentheparticipantsrespondedintheaffirmative forthreeormoredaysoftheweek.
Reduced physical activity was assessed using the Min-nesota Leisure Time Activities, a questionnaire designed by the AmericanCollege of Sports Medicine.18 Depending
onenergyoutput,individualswereclassifiedasmoderately active,activeandveryactive.Whentheywereclassifiedas sedentaryormoderatelyactivetheexistenceofthis pheno-typecriterionwasconsidered.
Speed ofwalkingwaschronometrically assessedasthe timespentforadistanceof4.57mandresultswereadjusted according to gender and stature, in keeping with Fried’s protocol.2ToassessMusclestrength,agrippingstrengthtest
wasmade, using the JAMAE balancing machine, withthe dominanthand.Resultswererecordedinkgofstrength(kgs) andadjustedaccordingtogenderandBMI.Participantswere distributedinthiscriterionaccordingtothecut offpoints describedintheliterature.2
Datacollectionwasmade duringthefirsthalf of2016, in town council premises with the town councils that had participated. Data wascollected by researchers who hadpreviouslystandardisedprotocolstominimisepossible measurementbiases.Ethical procedures werefollowed in keepingwiththedeclarationofHelsinki.Theresearchstudy wasapprovedbytheEthicsCommitteeoftheSenior Nurs-ingCollegeinCoimbra(no. 318/2015)andallparticipants signedinformedconsentforms.
ThesoftwareStatisticalPackagefortheSocialSciences (SPSS,version 21) wasused, withstandard procedures of descriptiveandanalyticalstatistics.Quantitativevariables wereexpressedasmeanandstandarddeviation and qual-itative data as percentages. Comparison of quantitative variablesaccordingtothegroupsofvariablefrailtywasused intheanalysisofvariance(ANOVA).Tocomparequalitative variablesandfrailtystatustheChisquared testwasused. Thefollowingvaluewasconsideredsignificant:p<0.05.
Results
Table1liststhesocio-demographicandclinical characteris-ticsof220elderlypeople.Thepredominance ofwomenin thesamplestoodout(68.6%).Thehighpercentageof par-ticipantswhostatedtheylivedalone(30.5%)wasalsohigh aswasthefactthatonly18.6%perceivedthemselvesas hav-ingagoodstateofhealth.Averageagewas75.8years.The prevalenceof frailty was23.6%.The other elderlypeople wereclassifiedaspre-frail(42.7%)andnotfrail(33.6%).
As suggestedby Table2,the percentageoffat didnot vary significantly between the different levels of frailty (p=0.742).Similarly, therewere nosignificant changesin bonemasswithregardstothediagnosisoffrailty(p=0.404). Results obtainedfor bodywater (p=0.222) may be inter-pretedinthesameway.Onthecontrary,intotalMM,the nonfrailindividualsmanaged46.9kg,comparedwith41.9kg inthepre-frailand40.0kginthefrail(p<0.001).Allresults obtainedin theMM, in arm andlegsegments, hadhigher scoresinthenonfrailelderly(p<0.001).
WithregardtotheproportionofindividualsbyBMI cate-goryandfrailtydiagnosis(Table3)itwasnotedthat41.2%of
Table1 Socio-demographicandclinicalcharacteristicsof theelderlypeople.
Participants(n=220) Gender,n(%) Women 151(68.6) Men 69(31.4) Maritalstatus,n(%) Single 5(2.3) Married 127(57.7) Divorced/separated 2(0.9) Widow 86(39.1) Cohabitation,n(%) Livesalone 67(30.5)
Liveswiththefamily 153(69.5)
Self-perceptionofhealth,n(%) Verygood 0(0.0) Good 41(18.6) OK 143(65.0) Bad 36(16.4) Frailty,n(%) Notfrail 74(33.6) Prefrail 94(42.7) Frail 52(23.6)
Ageinyears,mean±SD 75.8±6.9
SD:standarddeviation.
theelderlyclassifiedwithlowweightpresentedwithfrailty. In contrast, frailty only prevailed in 17.1% of eutrophic people,increasingagainto22.4%in theoverweightgroup (p<0.001).
Regarding nutritional status, the prevalence of frailty washigherinthe elderlyatrisk ofmalnutritionor under-nourishment(54.2%),whenwe comparedthem withthose verifiedin well nourishedelderly(19.9%).The association betweenthevariablesisstatisticallysignificant(p<0.001). Moreover,comparingthemeansobtainedintheMNA-SFfor thevariablefrailty(Table3),themeanwas13.9fornonfrail participants,13.3forpre-frailparticipantsand12.5forthe frail(p<0.001).
Discussion
This study sought toanalyse associations betweenfrailty, body composition andnutritional status in elderly people wholived athome. Socio-demographics revealedthat the sample meanagewasabove75,mostlyfemaleand hada tendencytobevulnerable,whichwasconfirmedbyprevious demographicreportscarriedoutinPortugal.19
Afrailtyprevalenceof23.6%wasfound,higherthanthat confirmedinthemajorityofepidemiologicalstudiescarried out in other European countries.7 Due to the rapid
age-ing of thepopulation, it is equally importantto carefully observetheprevalenceofpre-frailty(42.7%)andconsider that many of theseelderly peoplecould become frail,as ageanditsassociatedcomorbidityincreases.5Infact,
fur-therlongitudinalstudiesarerequiredinthisarea,inaddition tointerventionandresearch/healthactionstudiestoenable
Table2 Bodycompositionaccordingtofrailtystatus. Notfrail Mean±SD Pre-frail Mean±SD Frail Mean±SD Total Mean±SD pa Bodyfat(%) 30.0±7.6 30.8±7.2 30.7±8.2 30.5±7.5 0.742 Trunkfat(%) 27.2±7.1 27.0±7.5 26.3±8.3 26.9±7.5 0.791 Bonemass(kg) 2.5±0.5 2.5±2.2 2.2±0.4 2.4±1.5 0.404
TotalMusclemass(kg) 46.9±9.2 41.9±7.0 40.0±7.1 43.3±8.3 <0.001
MusclemassRA(kg) 2.7±0.8 2.2±0.5 2.1±0.4 2.4±0.6 <0.001
MusclemassLA(kg) 2.5±0.7 2.2±0.4 2.1±0.4 2.3±0.6 <0.001
MusclemassRILL(kg) 7.4±1.5 6.7±1.1 6.3±1.3 6.9±1.4 <0.001
MusclemassLL(kg) 7.5±1.6 6.8±1.1 6.5±1.3 6.9±1.4 <0.001
Bodywater(%) 50.6±5.4 49.3±4.7 49.4±5.3 49.7±5.1 0.222
RA:rightarm;LA:leftarm;SD:standarddeviation;kg:kilograms;RL:rightleg;LL:leftleg.
a UsingtheAnovatest.
Table3 Bodymassindexandnutritionalstatusaccordingtofrailtystatus. Notfrail n(%) Pre-frail n(%) Frails n(%) Total n(%) pa BMI <0.001 Underweight 5(14.7) 15(44.1) 14(41.2) 34(100.0) Eutrophic 24(34.3) 34(48.6) 12(17.1) 70(100.0) Overweight 45(38.8) 45(38.8) 26(22.4) 116(100.0) MNA-SF <0.001 Wellnourished 72(36.7) 85(43.4) 39(19.9) 196(100.0) Riskofmalnutrition andundernourished 2(8.3) 9(37.5) 13(54.2) 24(100.0) Notfrail Mean±SD Pre-frail Mean±SD Frail Mean±SD Total Mean±SD pb Weight(kg) 70.7±1.2 64.3±10.9 62.6±14.2 66.1±12.6 <0.001 Height(m) 1.59±0.09 1.56±0.08 1.53±0.10 1.56±0.09 <0.001 TotalofBMI(kg/m2) 28.0±4.3 26.5±4.1 26.7±5.6 27.0±4.6 0.089 TotalofMNA-SF 13.9±0.6 13.3±1.2 12.5±1.9 13.3±1.3 <0.001
SD:standarddeviation;BMI:bodymassindex;kg:kilograms; kg/m2:kilograms/statureinsquare metres;m: metres;MNA-SF:Mini
NutritionalAssessmentShortForm.
a UsingtheChi-squaredtest.
b UsingtheAnovatest.
preventionofthefrailtysyndrome.Inouropinion,socialand health policiesshouldenhancethe aimof keepingelderly peopleintegratedintotheirfamiliesandcommunities,with goodqualityoflifeandwell-being,foraslongaspossible.
Withregardstobodycompositionanalysiswiththe differ-entlevelsoffrailty,themostoutstandingfindingswasthat thephenotypeprofileoffrailelderlypeopleischaracterised bylowertotalMMandbysegments.Thefewstudieswhich haveanalysedthisassociationobtainedsimilarfindings.20,21
In Fried’s proposed cycle of neuroendocrine deregulation sarcopeniareducesmusclestrength,whichcanhavea nega-tiveeffectonseveralphenotypecharacteristics,suchasthe isometricstrengthofthehandorspeedofwalking.Several workssuggest thatreduction of MM is a determining fea-tureinthelossofmanualpressurestrength.8,22,23 Physical
trainingandrehabilitationprogrammesminimisefunctional impairmentandimprovehandstrength.9Forhealth
profes-sionalsthesefactsunderlinetheimportanceofpreventing
frailtynotjustthroughthemanagementofchronicdiseases butalsothroughrecommendationofphysicalactivity,with emphasis on muscle strength and resistance, particularly ofthehand-armsegment,whichisessentialfor successful executionofdailyactivities.TheWorldHealthOrganisation (WHO)provides guidelineson physical activity for elderly peoplewhich,togetherwithinterventionandspecific exer-cisesintheareaoffrailty24couldserveasorientativeguides
forcreatingprogrammesofprevention.
With regards toBMi, a statistically significant associa-tionwasobservedbetween itsclassificationandthe state offrailty.Byanalysingtheinformationingreaterdetail,we found that41.2% of elderly people withlow weightwere frail, but that a significant proportion of individuals who were overweight (22.4%) were also frail. Data appear to indicatethatbothunderandoverweightcouldleadto situa-tionsoffrailtyandbidirectionalitywhichwerealsooutlined in previous studies.3,25 This suggests that the association
344 L.SãoRomãoPretoetal. betweenBMI/frailtymaygobothways,onerelatedtolow
weightandsarcopeniaandtheother withsarcopenic obe-sity.
Findingsfromourstudyshowaclearassociationbetween MNA-SFandphenotypefrailty.Itiswellknownthatahealthy dietisadeterminingfeatureofhumanhealthandthat age-ing is a nutritionally vulnerable period in one’s life. The loweringinthenumberoftastebuds,lossofteeth, reduc-tioninsecretion bysupplementary digestivetractglands, reductionin baseline metabolism, amongothers, exposes theelderlypersontoahighernutritionalriskassociatedwith health. In the phenotypemodel of frailty, thenutritional status may affect two essential conditions: unintentional weightlossandfatigue/exhaustion.2
Arecentreviewbasedon32articlesconcludedthat mal-nutritionisa significant riskfactor in thedevelopmentof frailty syndrome.26 However, a balanced and moderately
hyperprotein diet,combinedwithcalcium andvitamin D supplements,appearstoimprovebone and musclehealth and reduce the risk of falls and fractures in frail elderly people.26 In the elderly population, in general, a varied
Mediterranean style diet, rich in proteins, micronutrients andvitaminDmayhelptomaintainanappropriate neuro-muscularbalanceandreducetheriskoffrailty.26,27
We underline the need to prevent andmanage frailty, notonlybytakingintoaccountthepossibletreatable medi-calcauses, butalso intervening inimportant pillars,such asphysical activity and nutritionalproblems. Nurses play a major role in these interdisciplinary interventions and should actively participate in decision-making on healthy ageingpolicies.
The main limitation to this research is its transversal nature,whichpreventsus,forexample,fromverifyinghow thevariablesstudiedcouldhaveaninfluenceonfrailtyand itsadverseevents.Afurtherlimitationtothestudywasnot knowingtheweightofthesampleayearbeforethestudy, duetothefactthatthisinformationwascollectedfromthe individualsthemselvesandwasthereforesubjective. How-ever,thestudyoffersinformationonlittleknownresearch onthefrailtysyndromeinPortugal.Italsodisclosesanalysis onthedifferent bodycomposition components differenti-atedbystagesoffrailty,whichlittleresearchhadpreviously covered.Finally,researchfindingscouldcontributetothe designofinterventionandactiveageingprogrammes.
Conflict
of
interests
Theauthorshavenoconflictofintereststodeclare.
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