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Yong Loo Lin
School of Medicine

Age without frailty

Published: 20 Jun 2017

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Half of older persons above the age of 55 living at home are frail, shared Associate Professor Ng Tze Pin from the NUS Yong Loo Lin School of Medicine. However, Assoc Prof Ng’s latest study shows that frailty — exhibiting signs of weakness, slowness, exhaustion, loss of muscle mass and reduced physical activity — may not be a necessary outcome of ageing. Under the four-year study titled the Singapore Frailty Intervention Trial (FIT), a combination of nutritional, physical and cognitive interventions was able to reverse physical frailty in older people.

Inspiration for the FIT stemmed from results of the Singapore Longitudinal Ageing Studies (SLAS), also led by Assoc Prof Ng. This ongoing long-term observational study investigates the overall health and ageing of a cohort of people above the age of 55, looking at their lifestyle, health, diet and nutrition, among other factors.

The findings of the SLAS revealed that physically frail elderly had a higher likelihood of becoming depressed or cognitively impaired, functionally disabled, hospitalised or dying prematurely.

“With such compelling evidence, if it is possible to reduce or even reverse physical frailty in the elderly, we could greatly improve their quality of life,” Assoc Prof Ng said.

Conducted between 2010 and 2013, the FIT involved some 250 community-living older people in Singapore — aged 65 and above — who showed signs of physical frailty. Each participant was randomly allocated into one of five groups. Four of the groups received lifestyle interventions — physical training, nutritional enhancement or cognitive training, with one group receiving a combination of all three. The last group did not receive any lifestyle interventions.

Physical training involved guided exercises targeted to increase muscle strength and improve balance, nutritional enhancement involved a nutritional supplement as well as education on ways to increase protein and calorie intake, and cognitive training included activities such as computer games and puzzles to train memory and visual-spatial skills.

The frailty of each participant was assessed before the start of the intervention as well as three months, six months and one year later.

“We found that better nutrition, physical training and mental exercises can reverse frailty, enhance muscle strength and gait speed, reduce depressive symptoms and improve cognitive functioning,” said Assoc Prof Ng.

He hopes that the results will encourage social service providers, voluntary welfare organisations, and healthcare practitioners to increase screening for elderly at risk of frailty, as well as provide education, nutritional supplementation and physical therapy support. Assoc Prof Ng and his team will work with the Geriatric Education and Research Institution and social service organisations to develop such community intervention programmes.

“The important message from our studies is that frailty is not an inevitable part of ageing. There is much that older people can do for themselves to avoid becoming frail and disabled, so it is vital that they pay attention to good quality diet and nutrition, engage in physical exercise, and participate in socially and cognitively stimulating activities,” Assoc Prof Ng emphasised.

This article was first published on 20 June 2017 in NUS News. See press release.

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