护理干预对老年慢性病患者死亡率影响的随机对照研究

目的：探讨护理干预对老年慢性病患者死亡率的影响。方法将老年慢性病患者随机分为对照组(n=872)和干预组(n=860)。对照组不做任何干预,干预组进行护理干预,干预时间6个月。干预前后采用抑郁自评量表(SDS)、社会功能缺陷筛选量表(SDSS)和日常生活能力评定量表(ADL)进行心理功能、社会功能及日常生活能力评定;随访5年后,观察老年慢性病患者的死亡率。结果干预后干预组老年慢性病患者 SDS 和 SDSS 评分均明显低于对照组,ADL 评分明显高于对照组,差异具有统计学意义(P <0.05);随访发现,干预组老年慢性病患者死亡率明显低于对照组,差异具有统计学意义(P <0.05)。结论护理干预能显著提高老年慢性病患者的心理功能、社会功能及日常生活能力,降低其死亡率。     

Physical Exercise Improves Function in Acutely Hospitalized Older Patients: Secondary Analysis of a Randomized Clinical Trial

ObjectivesTo evaluate the effects of an exercise intervention on physical function, maximal muscle strength, and muscle power in very old hospitalized patients.DesignIn a randomized controlled trial, 130 hospitalized patients were allocated to an exercise intervention (n = 65) or a control group (n = 65). The intervention consisted of a multicomponent exercise training program performed during 5-7 consecutive days (2 sessions/d). The usual care group received habitual hospital care, which included physical rehabilitation when needed.Setting and participantsAcute care for elderly unit. Older adults age >75 years.MeasuresPhysical function, assessed with the Short Physical Performance Battery test and the Gait Velocity Test (GVT), were the primary endpoints. The GVT was also administered under dual-task conditions (ie, verbal and arithmetic GVT). The functional tasks were recorded using an inertial sensor unit to determine the movement pattern. The secondary endpoints were maximal muscle strength and muscle power output.ResultsThe exercise intervention program provided significant benefits over usual care. At discharge (primary time point), the exercise group showed a mean increase of 1.7 points in the Short Physical Performance Battery scale (95% confidence interval [CI] 0.98, 2.42) and 0.14 m·s-1 in the GVT (95% CI 0.086, 0.194) over the usual care group. The intervention also improved the verbal (0.151; 95% CI 0.119, 0.184 vs ?0.001; 95% CI –0.025, 0.033 in the control group) and arithmetic GVT (0.115; 95% CI 0.077, 0.153 vs ?0.004; 95% CI –0.044, 0.035). Significant benefits were also observed in the intervention group in movement pattern, as well as in muscle strength and muscle power.Conclusions and implicationsAn individualized multicomponent exercise training program improves physical function, maximal muscle strength, and muscle power in acutely hospitalized older patients. These findings support the importance of physical exercise for avoiding the loss of physical functional capacity that frequently occurs during hospitalization in older adults.     

Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review

ObjectivesTo review the evidence on incidence and predictive factors of functional decline (FD) in nursing home (NH) residents.DesignA systematic review of the literature.Setting and ParticipantsLongitudinal studies involving individuals age 60 years and older living in a NH and with at least 2 functional capacity assessments were eligible.MethodsThe search was carried out up to June 2021 and was conducted in Embase, PubMed, Web of Science, Cochrane Library, CINAHL, Scopus, SciELO, and Google Scholar databases.ResultsA total of 27 studies met the eligibility criteria, most of which were prospective, recruiting participants in more than 1 NH, and conducted in a single country. Studies reported a high rate of functional dependency at baseline and FD at follow-up; in 1 year, 38.9% to 50.6% of residents experienced FD. Predictive factors of FD that were significant in at least 2 of the included studies were cognitive impairment, functional status at baseline, urinary incontinence, length of institutionalization, age, depression, being married, being male, and stroke disease. Protective factors were licensed nursing hours and presence of a geriatrician within the NH staff.Conclusions and ImplicationsThis review highlights the high incidence of FD in NH residents and identifies risk and protective factors of FD that may support the design of preventative strategies for this vulnerable and frail population.     

The Effect of Convergence Gamification Training in Community-Dwelling Older People: A Multicenter,Randomized Controlled Trial

ObjectivesIt is necessary to improve the health of older adults through exercise, but there is no concrete way to implement it or an environment in which they can exercise continuously. Our objective was to confirm the safety and efficacy of information technology (IT) convergence gamification exercise equipment for older adults. We tried to demonstrate equivalence to conventional exercise by comparing the functional improvement.DesignRandomized controlled trial, with 8-week-long IT convergence exercises 3 times a week vs conventional exercise.Setting and Participants40 community-dwelling participants aged 60-85 years.MethodParticipants were randomly divided into a conventional exercise group (group 1) and an IT convergence exercise group (group 2). Both groups were trained for 8 weeks, and functional assessment was performed before training (pre-evaluation), after training, and after 4 weeks of rest.ResultsThere were functional improvements in both groups. A comparison of the differences in the functional assessment between pre-evaluation and after 8 weeks of training yielded the following results. In group 1, the mean Five Times Sit to Stand Test–30 seconds was scored as 3.60 ± 2.56 (P < .015); Five Times Sit to Stand Test–5 times, ?1.75 ± 2.04 s (P < .015); Berg Balance Scale, 1.05 ± 1.39 (P < .015); Timed Up-and-Go test, ?0.64 ± 0.64 s (P < .015); and 10-m Walking Test, ?0.35 ± 0.47 s (P < .015). And in group 2, the mean Five Times Sit to Stand Test–30 seconds (s) was scored as 3.70 ± 2.62 (P < .015), Five Times Sit to Stand Test–5 times, ?1.65 ± 1.59 s (P < .015); Berg Balance Scale, 1.05 ± 1.00 (P < .015); Timed Up-and-Go test, ?0.93 ± 0.68 s (P < .015); 10-m Walking Test, ?0.41 ± 0.489 s (P < .015); Chair Sit and Reach test, 2.23 ± 3.19 cm (P < .015); and Korean version of the Falls Efficacy Scale–International, ?1.05 ± 1.43 (P < .015).Conclusion and ImplicationsThe results of this study suggest that the IT convergence gamification exercise equipment such as balpro110 has exercise effects similar to conventional exercise and also has advantages as an alternative to exercise for older adults in the next generation.     

The Effectiveness of a Proactive Multicomponent Intervention Program on Disability in Independently Living Older People: A Randomized Controlled Trial

Background

There is an increase in functional limitations and a decline in physical and mental well-being with age. Very few effective lifestyle interventions are available to prevent adverse outcomes such as disability in (pre-) frail older people. The effectiveness of an interdisciplinary multicomponent intervention program to prevent disability in older people in the community was tested.

Method

A randomized controlled trial (RCT) with a one-year follow-up was conducted in the Netherlands. Community-dwelling pre-frail older people aged 65 years and over were invited to participate. Frailty was measured with the Groningen Frailty Indicator (GFI) and categorized into non-frail (GFI=0), pre-frail (GFI = 1-3) and frail (GFI ≥ 4). The intervention program consisted of four components: a medication review, physical fitness, social skills, and nutrition.

Outcomes

The primary outcome was activity of daily living (ADL) measured with the Katz-6. Secondary outcomes were quality of life (SF-12) and healthcare consumption such as hospital admission, nursing home admission and primary care visits. Additional outcomes measured in the intervention group were physical fitness, Instrumental Activities of Daily Living (IADL), muscle strength, walking speed, functional capacity, mobility, feelings of depression and loneliness and nutritional status. The data were collected at baseline, after each intervention component and at a 12-month follow-up. An intention to treat analysis was used.

Results

In total, there were 290 participants, and 217 (74.8%) completed the study. The mean age was 74 (SD: 7.2), most were pre-frail (59.9%), the majority were female (55.2%), and the individuals were not living alone (61.4%). After the 12-month follow-up, the median Katz-6 score did not change significantly between the two groups; adjusted Odds Ratio (OR) = 0.96 (95% Confidence Interval (CI): 0.39-2.35, p-value 0.92). No statistically significant differences were observed between the groups for quality of life and healthcare consumption. Among the participants in the intervention group, IADL (Friedman’s test p <=0.04, X² =6.50), walking speed (Friedman’s test p <0.001, X² =19.09) and functional capacity (Friedman’s test p <0.001, X² =33.29) improved significantly after the one-year follow-up. Right-hand grip strength improved immediately after completion of the intervention (Wilcoxon signed-rank test p=0.00, z= -3.39) but not after the 12-month follow-up.

Conclusion

The intervention program did not significantly improve daily functioning, quality of life and healthcare consumption among (pre) frail community-dwelling older persons at the one-year follow-up. Participants in the intervention group experienced improvements in walking speed, functional capacity and instrumental activities of daily living. More research is needed to better understand why may benefit and how to identify the target population.

     

Impact of Game-Based Interventions on Health-Related Outcomes in Hospitalized Older Patients: A Systematic Review

ObjectivesTo examine the effectiveness of game-based interventions compared with usual care on health-related outcomes for acutely hospitalized older patients.DesignSystematic review of randomized controlled trials (RCT) and nonrandomized trials.Setting and ParticipantsAdults aged 65 years or older admitted to an Acute Care for Elderly unit were selected.MeasuresHealth-related outcomes (eg, functional capacity, quality of life, adherence to treatment).ResultsFour RCTs were included in the review. The interventions were based on the implementation of serious-game programs using Nintendo Wii in acute medical patients. Across the included studies, no significant differences were observed between groups on functional capacity and health-related quality of life. Significant differences were found between groups on the adherence to treatment (in favor of the control group), but no differences were obtained in other outcomes such as enjoyment and motivation.Conclusions and ImplicationsIn general, there is very limited evidence for the efficacy to reach conclusions about the effects of game-based interventions on health-related outcomes in acutely hospitalized older patients. Future studies are needed to improve our knowledge in the field; however, we consider that these strategies should be considered in the future complementary to usual care.     

Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis

ObjectivesHospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence.DesignMeta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. English-language searches to identify included studies were completed February 2018 and updated May 2018 of electronic databases and reference lists of studies and reviews. Included studies were human subjects investigations that measured ADL ≥2 time points before or during and after hospitalization and reported prevalence of ADL decline among older adults.SettingAcute care hospital units.ParticipantsAdults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375.MethodsIndependence in ADL was assessed using the Katz Index of Independence in Activities of Daily Living and Barthel Index of Independence in Activities of Daily Living.ResultsRandom effects meta-analysis across included studies identified combined prevalence of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal. A large amount of heterogeneity was observed between studies, which may be due in part to nonstandardized measurement of ADL impairment or other methodological differences.Conclusions and implicationsHospitalization in acute care poses a significant risk to functional independence of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence supports the continued need for hospital-based programs that provide assessment of functional ability and identification of at-risk older adults in order to better treat and prevent HAD.     

系统干预对脑卒中患者日常生活能力影响研究

目的探讨系统干预对脑卒中患者日常生活能力（ADL）、认知功能的影响,为有效干预提供依据。方法以神经内科住院的脑卒中患者为研究对象,将符合入选条件的脑卒中患者按“不平衡指数最小的原则”分为干预组和对照组,每组各50例,共100例。两组患者均接受神经内科常规治疗和护理,在此基础上干预组给予以提高ADL能力为目标的系统干预。系统干预小组由康复治疗师和康复护士组成,康复护士以Orem自我护理理论为指导,康复治疗师按Brunnstrom分期对脑卒中患者进行系统干预,分别在干预前、干预6周后应用简易智能量表（MMSE）和Barthel指数量表测量两组患者的认知功能及ADL。结果6周后,干预组Barthel指数总分、MMSE得分显著高于对照组,差异有统计学意义（P〈0．05）,Barthel指数10个分项目中除排尿、排便项目外,其余8个项目干预组得分均高于对照组,差异有统计学意义（P〈0．01）。结论系统干预可提高患者的日常生活活动能力,改善患者的认知功能。     

Associations Of Physical Activity And Body Mass Index With Activities Of Daily Living In Older Adults

Research reports about the associations of leisure-time physical activity (LPA) and Body Mass Index (BMI) with activities of daily living (ADL) - or instrumental activities of daily living (IADL)-dependent disability in older adults are inconclusive. Data were obtained from the 2000 Missouri Older Adult Needs Assessment Survey. Logistic regression was used to examine the associations of LPA and BMI with ADL-or IADL-dependent disability, while controlling for factors known to be associated with LPA, BMI, ADL and IADL. ADL-or IADL dependency decreased with LPA and increased with BMI regardless of each other’s level, presence of functional limitation, education, gender, race-ethnicity, and health care coverage. Physically active individuals were less likely than inactive ones to be ADL- or IADL-dependent. BMI was modestly associated with ADL- or IADL-dependency and this relationship was confounded by LPA. If confirmed by well designed longitudinal studies, LPA and BMI independent associations with ADL- or IADL-dependent disability lends supports to a strategy for improving older adult quality of life through improved physical activity. Etiological studies on the associations between risk factors and quality of life outcomes in older adults should consider the joint confounding effect of LPA and BMI.Eduardo J. Simoes, MD, Prevention Research Centers Program; Rosemarie Kobau, MPH and Lynda Anderson, PhD, Health Care and Aging Studies Branch; Ali Mokdad, PhD, Behavior Surveillance Branch, all at Coordinating Center for Health Promotion, NCCDPHP-DACH, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-K45. Atlanta, GA 30341,USA; Julie Kapp, PhD and Brian Waterman, MPH, Waterman Research Solutions, 5145 Shaw Ave., St. Louis, MO 63110, USA.     

Occupational Therapy Intervention: Effects on Self-Care,Performance, Satisfaction,Self-Esteem/Self-Efficacy,and Role Functioning of Older Hispanic Females with Arthritis

ABSTRACT

The purpose of this pilot study was to compare the effectiveness of occupation-based and enabling/preparatory interventions on self-care, perceived performance, satisfaction, self-efficacy, and role function among older Hispanic females with arthritis. A pre- and post-outcome measures design with semi-structured interview and questionnaire/rating scales was used with matched participants assigned to one of two intervention groups or a control, non-intervention group. For measures of task-specific functioning and self-efficacy, there were no statistically significant differences in average gain scores between the two interventions. Average gain scores were higher for the enabling/preparatory intervention than for the control group. For the occupational intervention, the scores were higher than for the control group for self-care/activities of daily living (ADL) functioning and self-esteem/self-efficacy. The results suggest that client-centered occupational therapy intervention provided within the home environment is beneficial for occupational performance, participation, role competence, and quality of life.     

Effects of a Multicomponent Frailty Prevention Program in Prefrail Community-Dwelling Older Persons: A Randomized Controlled Trial

ObjectiveTo examine the effects of a multicomponent frailty prevention program in community-dwelling older persons with prefrailty.DesignA randomized controlled trial.SettingA community elderly center in Hong Kong.ParticipantsPersons aged ≥50 years who scored 1-2 on a simple frailty questionnaire (FRAIL)MethodsParticipants (n = 127) were randomly assigned to a 12-week multicomponent frailty prevention program (exercise, cognitive training, board game activities) or to a wait-list control group. The primary outcomes were FRAIL scores, frailty status, and a combined frailty measure including subjective (FRAIL total score) and objective (grip strength, muscle endurance, balance, gait speed) measures. The secondary outcomes were verbal fluency assessed by dual-task gait speed, attention and memory assessed by digit span task, executive function assessed by the Frontal Assessment Battery, self-rated health, and life satisfaction. Assessments were conducted at baseline and at week 12.ResultsThe mean age of the participants was 62.2 years, and 88.2% were women. At week 12, the FRAIL score had decreased in the intervention group (−1.3, P < .001) but had increased in the control group (0.3, P < .01) (between-group differences P < .001). In addition, 83.3% and 1.6% of the intervention and control groups, respectively, had reversed from prefrailty to robust phenotype (between-group differences P < .001). Participants in the intervention group also had a greater reduction in the combined frailty score and greater improvements in muscle endurance, balance, verbal fluency, attention and memory, executive function, and self-rated health than those in the control group (all P < .05). There were no significant differences between the groups with respect to grip strength, gait speed, and life satisfaction.Conclusions and implicationsThe multicomponent frailty prevention program reduced frailty and improved physical and cognitive functions, and self-rated health in community-dwelling older persons with prefrailty. Findings can provide insights into the consideration of incorporating frailty prevention programs into the routine practice of community elderly services.     

The Effect of a Multicomponent Intervention on Quality of Life in Residents of Nursing Homes: A Randomized Controlled Trial (COSMOS)

Objectives

To investigate if the multicomponent intervention of the COSMOS trial, combining communication, systematic pain management, medication review, and activities, improved quality of life (QoL) in nursing home patients with complex needs.

Combined Effects of Cognitive Impairment and Nutritional Trajectories on Functional Recovery for Older Patients after Hip-Fracture Surgery

ObjectivesMalnutrition and cognitive impairment are associated with poor functional recovery in older adults following hip-fracture surgery. This study examined the combined effects of cognitive impairment and nutritional trajectories on postoperative functional recovery for older adults following hip-fracture surgery.DesignProspective longitudinal correlational study.Setting and ParticipantsThis study recruited 350 older adults (≥60 years of age) who received hip-fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020.MethodsParticipant data were collected over a 2-year period after surgery for nutritional and cognitive status and activities of daily living (ADLs). Participants were grouped by type of nutritional trajectory using group-based trajectory modeling. Generalized estimating equations analyzed associations between trajectory groups/cognitive status at discharge and performance of ADLs.ResultsNutritional trajectories best fit a 3-group trajectory model: malnourished (19%), at-risk of malnutrition (40%), and well-nourished (41%). Nutritional status for the malnourished group declined from 12 months to 24 months following surgery; nutritional status remained stable for at-risk of malnutrition and well-nourished groups. Interactions for cognitive impairment-by-nutritional status were significant: the malnourished + intact cognition subgroup had significantly better ADLs than the malnourished + cognitive impairment subgroup (b = 27.1, 95% confidence interval = 14.0–40.2; P < .001). For at-risk of malnutrition and well-nourished groups, there were no significant differences between cognitive impairment and intact cognition in ADLs. These findings suggest that nutritional status may buffer the negative effect of cognitive impairment on ADLs.Conclusions and ImplicationsBetter nutritional status over time for older adults following hip fracture can protect against adverse influences of cognitive impairment on ADLs during postoperative recovery. Participants with malnutrition and cognitive impairment had the poorest ADLs. These findings suggest interventions tailored to improving nutritional status may improve recovery for older adults following hip-fracture surgery.     

Association of Body Mass Index With All-Cause Mortality in Acutely Hospitalized Older Patients

ObjectivesThe aim was to examine the relationship between body mass index (BMI) and mortality in older hospitalized patients taking activities of daily living (ADLs) into account.DesignRetrospective cohort study.Setting and ParticipantsNationwide population-based study of all patients aged ≥65 years admitted to Danish geriatric medical departments during 2005 to 2014 and included in the National Danish Geriatric Database.MethodsPatients were followed until death, emigration, or study termination (December 31, 2015). Primary outcome was all-cause mortality. BMI and ADLs were routinely assessed on admission and linked at an individual level to the Danish national health registers. Kaplan-Meier analysis was used to estimate crude survival according to each BMI subcategory and Cox regression to examine the association with mortality adjusting for age, comorbidity, polypharmacy, ADLs, marital status, prior hospitalizations, and admission year.ResultsIn total, 74,589 patients (63% women) were included aged [mean (SD)] 82.5 (7.5) years with BMI [mean (SD)] of 23.9 (5.1) kg/m². During follow-up 51,188 died. Follow-up time was 191,972 person-years. Unadjusted and adjusted hazard ratio (HR) for overall, 30-day, and 1-year mortality decreased significantly with increasing BMI. In women, the highest adjusted HR (95% confidence interval) for overall mortality was seen for underweight patients (BMI <16) 1.83 (1.72–1.95) and the lowest for obesity grade II patients (BMI = 35.0–39.9) 0.66 (0.60–0.73) when using normal weight (BMI = 18.5–24.9) as reference. In men, the HR for BMI <16 and BMI = 35.0–39.9 were 1.98 (1.76–2.23) and 0.56 (0.49–0.65), respectively.Conclusions and ImplicationsIn hospitalized older patients, association between mortality and BMI did not show a U-shaped or J-shaped curve after adjustment of multiple confounders, including ADLs. Instead, mortality was highest in patients with low BMI and decreased with increasing BMI before leveling off in the obese range. Our study highlights the need for a debate and reassessment of what should be the ideal BMI in this vulnerable patient group.     

Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review

Objective

To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.

Study Design

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.

Results

In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.

Conclusion

This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.     

The Effects of Exercise on Falls in Older People With Dementia Living in Nursing Homes: A Randomized Controlled Trial

ObjectivesTo investigate exercise effects on falls in people with dementia living in nursing homes, and whether effects were dependent on sex, dementia type, or improvement in balance. A further aim was to describe the occurrence of fall-related injuries.DesignA cluster-randomized controlled trial.Setting and ParticipantsThe Umeå Dementia and Exercise study was set in 16 nursing homes in Umeå, Sweden and included 141 women and 45 men, a mean age of 85 years, and with a mean Mini-Mental State Examination score of 15.InterventionParticipants were randomized to the high-intensity functional exercise program or a seated attention control activity; each conducted 2-3 times per week for 4 months.MeasuresFalls and fall-related injuries were followed for 12 months (after intervention completion) by blinded review of medical records. Injuries were classified according to severity.ResultsDuring follow-up, 118 (67%) of the participants fell 473 times in total. At the interim 6-month follow-up, the incidence rate was 2.7 and 2.8 falls per person-year in exercise and control group, respectively, and at 12-month follow-up 3.0 and 3.2 falls per person-year, respectively. Negative binomial regression analyses indicated no difference in fall rate between groups at 6 or 12 months (incidence rate ratio 0.9, 95% confidence interval (CI) 0.5–1.7, P = .838 and incidence rate ratio 0.9, 95% CI 0.5–1.6, P = .782, respectively). No differences in exercise effects were found according to sex, dementia type, or improvement in balance. Participants in the exercise group were less likely to sustain moderate/serious fall-related injuries at 12-month follow-up (odds ratio 0.31, 95% CI 0.10–0.94, P = .039).Conclusions/ImplicationsIn older people with dementia living in nursing homes, a high-intensity functional exercise program alone did not prevent falls when compared with an attention control group. In high-risk populations, in which multimorbidity and polypharmacy are common, a multifactorial fall-prevention approach may be required. Encouraging effects on fall-related injuries were observed, which merits future investigations.     

Randomized Controlled Trial for Promotion of Healthy Eating in Older Adults by Increasing Consumption of Plant-Based Foods: Effect on Inflammatory Biomarkers

To what extent the intake of fruit and vegetables (FV) influences inflammatory status remains elusive, particularly in older populations. The aim of the present study was to determine the effect of increased FV intake for 16 weeks on circulating biomarkers of inflammation in a population of older men and women. Sixty-six participants (65–70 years) randomly assigned to either FV or control (CON) groups were instructed to increase FV intake to five servings per day through nutritional counseling (FV) or to maintain habitual diet (CON). Dietary intake and physical activity level (PA) were determined using food frequency questionnaire and accelerometers, respectively, at the start and end of the intervention. C-reactive protein (CRP), interleukin 6 (IL-6), IL-18, macrophage inflammatory protein-1α (MIP-1α), MIP-1β, tumor necrosis factor-α (TNF-α), TNF-related apoptosis-inducing ligand (TRAIL), TNF-related activation-induced cytokine (TRANCE), and C-X3-C motif chemokine ligand-1 (CX3CL1, or fractalkine) were analyzed. The FV group significantly increased daily FV intake (from 2.2 ± 1.3 to 4.2 ± 1.8 servings/day), with no change in CON. Waist circumference and PA level were unchanged by the intervention. Interaction effects (time × group, p < 0.05) for TRAIL, TRANCE, and CX3CL1 denoting a significant decrease (p < 0.05) in FV but not in CON were observed. No corresponding effects on CRP, IL6, TNF-α, MIP-1α, and β and IL-18 were observed. The present study demonstrates the influence of increased FV consumption on levels of some inflammatory biomarkers in a population of older adults. Future work is warranted to examine the clinical implications of FV-induced alterations in these inflammatory biomarkers.     

Randomized Controlled Trial of Exercise and Nutrition Supplementation on Physical and Cognitive Function in Older Chinese Adults Aged 50 Years and Older

ObjectivesTo assess whether a 24-week multidomain lifestyle intervention including a nutritional milk supplement and an exercise program had any effect on physical and cognitive function, self-rated health, and health-related quality of life in older Chinese adults.DesignRandomized controlled trial.Setting and participantsCommunity-living people aged 50 years and older.Methods180 participants (mean age 61 ± 6 years) were randomized to 24 weeks of exercise plus nutrition supplementation or no intervention. The primary outcome was gait speed, with additional physical and cognitive function measures, self-rated health, and health-related quality of life as secondary outcomes. Information collected also included dietary intake by 3-day dietary records, and blood sampling for renal function, glycated hemoglobin, serum vitamin B₁₂, 25-hydroxyvitamin D, and biochemical indices of bone turnover.ResultsThere was no significant group difference in the change of gait speed, muscle strength, muscle power, cardiovascular fitness, or cognitive function over time, either by intention-to-treat or per-protocol analysis. A significant time × group effect (P = .039) on self-rated health was detected, but there was no significant time or time × group difference in the change of physical and mental health-related quality of life measures over time. In addition, moderate physical activity level was greatly increased from baseline to 24 weeks in the intervention group compared with the control group.Conclusions and implicationsA 24-week exercise and nutrition supplementation program among community-living people in late midlife to early old age improved self-rated health and the overall level of physical activity, without objective improvements in physical and cognitive function.     

Effect of Ginger Supplementation on Proinflammatory Cytokines in Older Patients with Osteoarthritis: Outcomes of a Randomized Controlled Clinical Trial

There is limited evidence that ginger powder consumption can relieve pain and inflammation due to specific anti-inflammatory phytochemical constitutents. This study investigates the effect of ginger supplementation on proinflammatory factors in participants (n = 120) of a randomized double-blind placebo-controlled 3-month clinical trial investigating knee osteoarthritis. Patients were randomly assigned to one of two groups: the ginger group (GG) or the placebo group (PG). Administered daily for 3 months, participants in the GG intervention received capsules containing 500 mg of ginger powder, while PG participants received capsules filled with 500 mg starch. Serum samples collected at baseline and 3 months were analyzed for serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). At baseline, proinflammatory cytokine concentrations did not differ by group. However, at 3 months, both cytokines decreased in the GG relative to the PG. The results of this study indicate that ginger supplementation may have a promising benefits for knee osteoarthritis and may, therefore, may warrant further study.