Impact on Physical Function of the +AGIL Barcelona Program in Community-dwelling Older Adults with Cognitive Impairment: an Interventional Cohort Study

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2023 Nov 14

PMID 37957601

Authors

Cristina Arnal

L Monica Perez

Luis Soto

Alvaro Casas Herrero

Joan Ars

Sonia Baro

Francisco Diaz

Araceli Abilla

M Belen Enfedaque

Matteo Cesari

Marco Inzitari

Affiliations

Soon will be listed here.

Abstract

Background: Older adults with cognitive impairment (CI) have higher multimorbidity and frailty prevalence, lower functional status and an increased likelihood to develop dementia, non-cognitive deficits, and adverse health-related events. +AGIL, a real-world program for frail older adults in a primary care area of Barcelona, is a pragmatic, multi-component and integrated intervention implemented since 2016. It includes physical activity, nutrition, sleep hygiene, revision and adequacy of pharmacological treatment, detection of undesired loneliness and screening for CI; to improve physical function in community-dwelling older adults. We aimed to assess the + AGIL longitudinal impact on physical function among community-dwelling frail older persons with CI.

Methods: An interventional cohort study included data from all the + AGIL consecutive participants from July 2016 until March 2020. Based on the comprehensive geriatric assessment, participants were offered a tailored multi-component community intervention, including a 10-week physical activity program led by an expert physical therapist. Physical performance was measured at baseline, three and six months follow-up. The pre-post impact on physical function was assessed by paired sample t-test for repeated samples. Linear mixed models were applied to analyze the + AGIL longitudinal impact. P-values < 0.05 were considered statistically significant.

Results: 194 participants were included (82 with CI, based on previous diagnosis or the Mini-COG screening tool), 68% women, mean age 81.6 (SD = 5.8) yo. Participants were mostly independent in Activities of Daily Living (mean Barthel = 92.4, SD = 11.1). The physical activity program showed high adherence (87.6% attended ≥ 75% sessions). At three months, there was a clinically and statistically significant improvement in the Short Physical Performance Battery (SPPB) and its subcomponents in the whole sample and after stratification for CI [CI group improvements: SPPB = 1.1 (SD = 1.8) points, gait speed (GS) = 0.05 (SD = 0.13) m/s, Chair stand test (CST)=-2.6 (SD = 11.4) s. Non-CI group improvements: SPPB = 1.6 (SD = 1.8) points, GS = 0.08 (SD = 0.13) m/s, CST=-6.4 (SD = 12.1) seg]. SPPB and gait speed remained stable at six months in the study sample and subgroups. CI had no significant impact on SPPB or GS improvements.

Conclusion: Our results suggest that older adults with CI can benefit from a multidisciplinary integrated and comprehensive geriatric intervention to improve physical function, a component of frailty.

References

Tyrovolas S, Koyanagi A, Lara E, Santini Z, Haro J . Mild cognitive impairment is associated with falls among older adults: Findings from the Irish Longitudinal Study on Ageing (TILDA). Exp Gerontol. 2015; 75:42-7. DOI: 10.1016/j.exger.2015.12.008. View

Cesari M, Calvani R, Marzetti E . Frailty in Older Persons. Clin Geriatr Med. 2017; 33(3):293-303. DOI: 10.1016/j.cger.2017.02.002. View

Jeong M, Park K, Ryu J, Kim G, Jung H, Park H . Multi-Component Intervention Program on Habitual Physical Activity Parameters and Cognitive Function in Patients with Mild Cognitive Impairment: A Randomized Controlled Trial. Int J Environ Res Public Health. 2021; 18(12). PMC: 8296099. DOI: 10.3390/ijerph18126240. View

Shephard J, Kosslyn S . The minicog rapid assessment battery: developing a "blood pressure cuff for the mind". Aviat Space Environ Med. 2005; 76(6 Suppl):B192-7. View

Cadore E, Bays Moneo A, Mensat M, Munoz A, Casas-Herrero A, Rodriguez-Manas L . Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age (Dordr). 2013; 36(2):801-11. PMC: 4039260. DOI: 10.1007/s11357-013-9599-7. View

Kwon S, Perera S, Pahor M, Katula J, King A, Groessl E . What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study). J Nutr Health Aging. 2009; 13(6):538-44. PMC: 3100159. DOI: 10.1007/s12603-009-0104-z. View

Hamer M, Chida Y . Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med. 2008; 39(1):3-11. DOI: 10.1017/S0033291708003681. View

Delbaere K, Kochan N, Close J, Menant J, Sturnieks D, Brodaty H . Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry. 2012; 20(10):845-53. DOI: 10.1097/JGP.0b013e31824afbc4. View

Peel N, Alapatt L, Jones L, Hubbard R . The Association Between Gait Speed and Cognitive Status in Community-Dwelling Older People: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci. 2018; 74(6):943-948. DOI: 10.1093/gerona/gly140. View

10.

Camicioli R, Majumdar S . Relationship between mild cognitive impairment and falls in older people with and without Parkinson's disease: 1-Year Prospective Cohort Study. Gait Posture. 2010; 32(1):87-91. DOI: 10.1016/j.gaitpost.2010.03.013. View

11.

Guralnik J, Ferrucci L, Pieper C, Leveille S, Markides K, Ostir G . Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000; 55(4):M221-31. DOI: 10.1093/gerona/55.4.m221. View

12.

de Bruijn R, Schrijvers E, de Groot K, Witteman J, Hofman A, Franco O . The association between physical activity and dementia in an elderly population: the Rotterdam Study. Eur J Epidemiol. 2013; 28(3):277-83. DOI: 10.1007/s10654-013-9773-3. View

13.

Steffl M, Bohannon R, Sontakova L, Tufano J, Shiells K, Holmerova I . Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis. Clin Interv Aging. 2017; 12:835-845. PMC: 5441519. DOI: 10.2147/CIA.S132940. View

14.

Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez M . Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA Intern Med. 2015; 175(7):1094-1103. DOI: 10.1001/jamainternmed.2015.1668. View

15.

Liu C, Latham N . Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 2009; (3):CD002759. PMC: 4324332. DOI: 10.1002/14651858.CD002759.pub2. View

16.

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

17.

Scarmeas N, Anastasiou C, Yannakoulia M . Nutrition and prevention of cognitive impairment. Lancet Neurol. 2018; 17(11):1006-1015. DOI: 10.1016/S1474-4422(18)30338-7. View

18.

Avila-Funes J, Amieva H, Barberger-Gateau P, Le Goff M, Raoux N, Ritchie K . Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc. 2009; 57(3):453-61. DOI: 10.1111/j.1532-5415.2008.02136.x. View

19.

Guyonnet S, Secher M, Ghisolfi A, Ritz P, Vellas B . Nutrition, Frailty and Prevention of Disabilities with Aging. J Frailty Aging. 2016; 4(1):13-25. DOI: 10.14283/jfa.2015.36. View

20.

Roman G, Jackson R, Gadhia R, Roman A, Reis J . Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in prevention of stroke, age-related cognitive decline, and Alzheimer disease. Rev Neurol (Paris). 2019; 175(10):724-741. DOI: 10.1016/j.neurol.2019.08.005. View