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Nutrition and Exercise Health Services for Older Adults: A Focus...
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Nutrition and Exercise Health Services for Older Adults: A Focus on Frailty

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Health Assessments".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 2634

Special Issue Editor

Dr. Chad Yixian Han

E-Mail Website
Guest Editor
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
Interests: nutrition and exercise; older adults; cancer survivorship

Special Issue Information

Dear Colleagues,

Frailty is not a disease or disability; rather, it is a clinical syndrome. It has been defined by Fried et al as a clinical syndrome if a combination of three or more of the following symptoms are present: unintentional weight loss, weakness, exhaustion, slowness and reduced physical activity. By contrast, pre-frailty is defined as having only one or two of these criteria. Currently, many expert working groups, such as the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), recommend multifaceted interventions that combine exercise and nutrition as part of management strategies for pre-frail and frail hospitalized older adults. Over the last few decades, research in nutrition and exercise around frail older adults has seen significant progress. Nonetheless, the strength of the evidence from the research conducted is limited by inconsistencies from the results of the studies cited for their recommendations.

In this Special Issue, we would like to offer the opportunity to uncover and expand the body of evidence that centers on nutrition and/or exercise services catered to pre-frail and frail older adults within health systems. Consequently, all original research articles and reviews (e.g., narrative, scoping, systematic) are welcome. Articles focusing on frail and pre-frail older adults will be prioritized; however, articles covering nutrition and exercise services for older adults in other chronic disease populations, such as cancer survivors or those experiencing multimorbidity with a high risk of frailty, will also be considered.

I look forward to receiving your contributions.

Dr. Chad Yixian Han
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • nutrition
  • exercise
  • older adults
  • health service
  • frailty
  • pre-frailty

Published Papers (3 papers)

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Research

13 pages, 223 KiB  
Article
A Cost–Consequence Analysis of Nutritional Interventions Used in Hospital Settings for Older Adults with or at Risk of Malnutrition
by Alvin Wong, Yingxiao Huang, Merrilyn D. Banks, P. Marcin Sowa and Judy D. Bauer
Healthcare 2024, 12(10), 1041; https://doi.org/10.3390/healthcare12101041 - 17 May 2024
Viewed by 474
Abstract
Background: Malnutrition is a significant and prevalent issue in hospital settings, associated with increased morbidity and mortality, longer hospital stays, higher readmission rates, and greater healthcare costs. Despite the potential impact of nutritional interventions on patient outcomes, there is a paucity of research [...] Read more.
Background: Malnutrition is a significant and prevalent issue in hospital settings, associated with increased morbidity and mortality, longer hospital stays, higher readmission rates, and greater healthcare costs. Despite the potential impact of nutritional interventions on patient outcomes, there is a paucity of research focusing on their economic evaluation in the hospital setting. This study aims to fill this gap by conducting a cost–consequence analysis (CCA) of nutritional interventions targeting malnutrition in the hospital setting. Methods: We performed a CCA using data from recent systematic reviews and meta-analyses, focusing on older adult patients with or at risk of malnutrition in the hospital setting. The analysis included outcomes such as 30-day, 6-month, and 12-month mortality; 30-day and 6-month readmissions; hospital complications; length of stay; and disability-adjusted life years (DALYs). Sensitivity analyses were conducted to evaluate the impact of varying success rates in treating malnutrition and the proportions of malnourished patients seen by dietitians in SingHealth institutions. Results: The CCA indicated that 28.15 DALYs were averted across three SingHealth institutions due to the successful treatment or prevention of malnutrition by dietitians from 1 April 2021 to 31 March 2022, for an estimated 45,000 patients. The sensitivity analyses showed that the total DALYs averted ranged from 21.98 (53% success rate) to 40.03 (100% of malnourished patients seen by dietitians). The cost of implementing a complex nutritional intervention was USD 218.72 (USD 104.59, USD 478.40) per patient during hospitalization, with additional costs of USD 814.27 (USD 397.69, USD 1212.74) when the intervention was extended for three months post-discharge and USD 638.77 (USD 602.05, USD 1185.90) for concurrent therapy or exercise interventions. Conclusion: Nutritional interventions targeting malnutrition in hospital settings can have significant clinical and economic benefits. The CCA provides valuable insights into the costs and outcomes associated with these interventions, helping healthcare providers and policymakers to make informed decisions on resource allocation and intervention prioritization. Full article
(This article belongs to the Special Issue Nutrition and Exercise Health Services for Older Adults: A Focus on Frailty)
14 pages, 615 KiB  
Article
A Conceptual Study on Characterizing the Complexity of Nutritional Interventions for Malnourished Older Adults in Hospital Settings: An Umbrella Review Approach
by Alvin Wong, Yingxiao Huang, Merrilyn D. Banks, P. Marcin Sowa and Judy D. Bauer
Healthcare 2024, 12(7), 765; https://doi.org/10.3390/healthcare12070765 - 31 Mar 2024
Cited by 1 | Viewed by 824
Abstract
Introduction: Malnutrition is a widespread and intricate issue among hospitalized adults, necessitating a wide variety of nutritional strategies to address its root causes and repercussions. The primary objective of this study is to systematically categorize nutritional interventions into simple or complex, based on [...] Read more.
Introduction: Malnutrition is a widespread and intricate issue among hospitalized adults, necessitating a wide variety of nutritional strategies to address its root causes and repercussions. The primary objective of this study is to systematically categorize nutritional interventions into simple or complex, based on their resource allocation, strategies employed, and predictors of intervention complexity in the context of adult malnutrition in hospital settings. Methods: A conceptual evaluation of 100 nutritional intervention studies for adult malnutrition was conducted based on data from a recent umbrella review (patient population of mean age > 60 years). The complexity of interventions was categorized using the Medical Research Council 2021 Framework for Complex Interventions. A logistic regression analysis was employed to recognize variables predicting the complexity of interventions. Results: Interventions were divided into three principal categories: education and training (ET), exogenous nutrient provision (EN), and environment and services (ES). Most interventions (66%) addressed two or more of these areas. A majority of interventions were delivered in a hospital (n = 75) or a hospital-to-community setting (n = 25), with 64 studies being classified as complex interventions. The logistic regression analysis revealed three variables associated with intervention complexity: the number of strategies utilized, the targeted areas, and the involvement of healthcare professionals. Complex interventions were more likely to be tailored to individual needs and engage multiple healthcare providers. Conclusions: The study underlines the importance of considering intervention complexity in addressing adult malnutrition. Findings advocate for a comprehensive approach to characterizing and evaluating nutritional interventions in future research. Subsequent investigations should explore optimal balances between intervention complexity and resource allocation, and assess the effectiveness of complex interventions across various settings, while considering novel approaches like telehealth. Full article
(This article belongs to the Special Issue Nutrition and Exercise Health Services for Older Adults: A Focus on Frailty)
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17 pages, 271 KiB  
Article
Barriers and Enablers to a Hospital-to-Home, Combined Exercise and Nutrition, Self-Managed Program for Pre-Frail and Frail Hospitalised Older Adults
by Chad Yixian Han, Georgia Middleton, Jersyn Doh, Alison Yaxley, Yogesh Sharma, Claire Baldwin and Michelle Miller
Healthcare 2024, 12(6), 678; https://doi.org/10.3390/healthcare12060678 - 18 Mar 2024
Viewed by 958
Abstract
Introduction: Self-managed exercise and nutrition interventions can alleviate pre-frailty and frailty but understanding of adherence to them is lacking. This study aimed to explore the experiences of, and barriers and enablers to, a hospital-to-home self-managed combined exercise and nutrition program for hospitalised older [...] Read more.
Introduction: Self-managed exercise and nutrition interventions can alleviate pre-frailty and frailty but understanding of adherence to them is lacking. This study aimed to explore the experiences of, and barriers and enablers to, a hospital-to-home self-managed combined exercise and nutrition program for hospitalised older adults living with pre-frailty and frailty. Methods: A hybrid approach to data- and theory-driven descriptive thematic analysis identified experiences, barriers, and enablers to participation in a 3-month, self-managed, exercise–nutrition, hospital-to-home frailty-support program. Pre-frail and frail older adult patients ≥ 65 years admitted to the acute medical unit at a South Australian tertiary hospital were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim, and analysed descriptively, using the Theoretical Domains Framework. Results: The nutrition component of the program found 11 common barriers and 18 common enablers. The exercise component included 14 barriers and 24 enablers. Intentions, Social influences, Environmental context/resource and Emotions served as primary barriers towards adherence to both components. Common enablers for both components included Knowledge, Social identity, Environmental context/resource, Social influences, and Emotions. Conclusions: This research revealed important factors affecting adherence to a self-managed exercise–nutrition program in pre-frail and frail older adults within the environment, resources, and emotion domains that should be considered when designing other intervention programs in this population group. Full article
(This article belongs to the Special Issue Nutrition and Exercise Health Services for Older Adults: A Focus on Frailty)
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