Identifying effective and feasible interventions to accelerate functional recovery from hospitalization in older adults: A randomized controlled pilot trial

Abstract

Hospitalization induces functional decline in older adults. Many geriatric patients fail to fully recover physical function after hospitalization, which increases the risk of frailty, disability, dependence, re-hospitalization, and mortality. There is a lack of evidence-based therapies that can be implemented following hospitalization to accelerate functional improvements. The aims of this Phase I clinical trial are to determine 1) the effect size and variability of targeted interventions in accelerating functional recovery from hospitalization and 2) the feasibility of implementing such interventions in community-dwelling older adults. Older patients (≥65 yr, n=100) will be recruited from a single site during hospitalization for an acute medical condition. Subjects will be randomized to one of five interventions initiated immediately upon discharge: 1. protein supplementation, 2. in-home rehabilitation plus placebo supplementation, 3. in-home rehabilitation plus protein supplementation, 4. single testosterone injection, or 5. isocaloric placebo supplementation. Testing will occur during hospitalization (baseline) and at 1 and 4 weeks post discharge. Each testing session will include measures of muscle strength, physical function/performance, body composition, and psychological function. Physical activity levels will be continuously monitored throughout study participation. Feasibility will be determined through collection of the number of eligible, contacted, and enrolled patients; intervention adherence and compliance; and reasons for declining enrollment and study withdrawal. This research will determine the feasibility of post-hospitalization strategies to improve physical function in older adults. These results will also provide a foundation for performing larger, multi-site clinical trials to improve physical function and reduce readmissions in geriatric patents.

Protein Requirements in Critically Ill Older Adults

“…In frail but otherwise-healthy older adults, an adequate (15 g) supplementation of high-quality protein at breakfast and lunch was shown to increase physical function. In addition, we recently reported that 30 days of protein supplementation (20 g twice daily) was feasible and increased physical function as measured by the short physical performance battery in older patients after an acute hospitalization [ 51 , 52 ]. The benefits of protein/amino acid supplementation on skeletal muscle health has been shown to be achievable during a 2–3 week time frame in clinical populations [ 53 ] or models of clinical settings [ 54 ].…”

Growing Relevance of Cardiac Rehabilitation for an Older Population With Heart Failure

“…CR programs can help transition patients with HF from hospitalization-to-home as well as from skilled nursing facility-to-home with valuable supervision and guidance of physical activity to reduce the effects of hospital-related deconditioning. 19 CR programs also provide opportunities to review medications and goals of care to ensure management is well-directed, wellcoordinated, and patient-centered. This reduces the chance of unchecked medication interactions and unnecessary polypharmacy.…”

Beneficial Effects of Leucine Supplementation on Criteria for Sarcopenia: A Systematic Review

“…Within the framework of the Third National Health and Nutrition Examination Survey, Srikanthan and Karlamangla [12] have demonstrated that muscle mass is a predictor of longevity when taking into account the all-cause mortality in North American adults (aged over 55 or 65 years for men and women, respectively). One of the main ways in which sarcopenia contributes to the disease is that it alters muscular turnover and metabolism [15,16]. Moreover, older adults exhibit a decreased anabolic response to protein feeding [17,18], which is a mechanism underpinning the loss of muscle mass in sarcopenic individuals.…”