Randomized Controlled Trial of Community-based Nutritional, Physical and Cognitive Training Intervention Programmes for At Risk Frail Elderly

Community-living elderly persons are screened and 250 participants satisfying rigorous criteria for frailty are randomized to received nutritional, physical training, cognitive training, combined or control arms for 24 weeks and followed up for 12 months. Baseline evaluations will include an extensive range of potential markers of frailty and outcome measures, including functional disability and hospitalizations.

Frail subjects who were selected for the interventional trial (N=250) are followed up at 3, 6 and 12 months after baseline assessment. Non-trial subjects (about 2750) are followed up at 1 year after baseline assessment

Inclusion criteria

• Age of 65 years or older
• Living at home
• Able to walk without personal assistance and no other physical limitations that can limit participation and adherence, particularly to exercise intervention programme
• Meet criteria for frailty

Operational definition of frailty.

The participants are assessed and classified on the level of frailty by the following measures and criteria:

• Weight loss
• Slowness
• Poor balance and weakness assessed by chair stand test
• Muscle weakness assessed by hand grip and knee extension strength
• Exhaustion, fatigue or low endurance
• Low physical activity

Exclusion criteria

• Member of household already enrolled
• Dementia or cognitive impairment, major depression or other psychotic disorders
• Severe audio-visual impairment
• Progressive, degenerative neurologic disease like Parkinsonism, fits/ epilepsy, etc
• Rapidly progressive or terminal illness under palliative care with life expectancy less than 12 months
• History of alcohol abuse or any other substance abuse
• Severely affect muscle/joint dysfunction resulting in disability
• Hospital admission in the past 3 months
• Regular physical training or physiotherapy or current participation in a vigorous exercise or weight-training program more than once per week
• Undergoing therapeutic diet incompatible with nutritional supplementation
• In the opinion of research clinician, the intervention is deemed to be potentially hazardous for the subject, such as serious cardiac and pulmonary disease.