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Background Frailty is a geriatric syndrome that affects multiple domains of human functioning. A variety of problems contributes to the development of this syndrome; poor nutritional status is an important determinant of this condition. The purpose of this systematic review was to examine recent evidence regarding the association between nutritional status and frailty syndrome in older adults. Methods PubMed, Web of Science, and Scopus electronic databases were searched using specific key words, for observational papers that were published during the period from 2005 to February 2017 and that studied the association or relationship between nutritional status and frailty in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was followed to assess the quality of the included articles. Results Of the 2042 studies found, nineteen met the inclusion criteria. Of these studies, five provided data on micronutrients and frailty, and reported that frailty syndrome is associated with low intakes of specific micronutrients. Five studies provided data on macronutrients and frailty, and among those studies, four revealed that a higher protein intake was associated with a lower risk of frailty. Three studies examined the relationship between diet quality and frailty, and showed that the quality of the diet is inversely associated with the risk of being frail. Two studies provided data on the antioxidant capacity of the diet and frailty, and reported that a high dietary antioxidant capacity is associated with a lower risk of developing frailty. Finally, seven studies evaluated the relationship between scores on both the Mini Nutritional Assessment (MNA) and the MNA-SF (Short Form) and frailty, and revealed an association between malnutrition and/or the risk of malnutrition and frailty. Conclusions This systematic review confirms the importance of both quantitative (energy intake) and qualitative (nutrient quality) factors of nutrition in the development of frailty syndrome in older adults. However, more longitudinal studies on this topic are required to further understand the potential role of nutrition in the prevention, postponement, or even reversion of frailty syndrome.

Background Low physical activity has been shown to be one of the most common components of frailty, and interventions have been considered to prevent or reverse this syndrome. The purpose of this systematic review of randomized, controlled trials is to examine the exercise interventions to manage frailty in older people. Methods The PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched using specific keywords and Medical Subject Headings for randomized, controlled trials published during the period of 2003–2015, which enrolled frail older adults in an exercise intervention program. Studies where frailty had been defined were included in the review. A narrative synthesis approach was performed to examine the results. The Physiotherapy Evidence Database (PEDro scale) was used to assess the methodological quality of the selected studies. Results Of 507 articles, nine papers met the inclusion criteria. Of these, six included multi-component exercise interventions (aerobic and resistance training not coexisting in the intervention), one included physical comprehensive training, and two included exercises based on strength training. All nine of these trials included a control group receiving no treatment, maintaining their habitual lifestyle or using a home-based low level exercise program. Five investigated the effects of exercise on falls, and among them, three found a positive impact of exercise interventions on this parameter. Six trials reported the effects of exercise training on several aspects of mobility, and among them, four showed enhancements in several measurements of this outcome. Three trials focused on the effects of exercise intervention on balance performance, and one demonstrated enhanced balance. Four trials investigated functional ability, and two showed positive results after the intervention. Seven trials investigated the effects of exercise intervention on muscle strength, and five of them reported increases; three trials investigated the effects of exercise training on body composition, finding improvements in this parameter in two of them; finally, one trial investigated the effects of exercise on frailty using Fried’s criteria and found an improvement in this measurement. Exercise interventions have demonstrated improvement in different outcome measurements in frail older adults, however, there were large differences between studies with regard to effect sizes. Conclusions This systematic review suggested that frail older adults seemed to benefit from exercise interventions, although the optimal program remains unclear. More studies of this topic and with frail populations are needed to select the most favorable exercise program.

Physical exercise, when practiced regularly and in adequate doses, is a proven nonpharmacological measure that helps to prevent and reverse noncommunicable diseases, as well as reduce mortality rates from any cause. In general, older adults perform insufficient physical activity and do not meet the doses recommended by the World Health Organization for the improvement of health through physical activity. However, there is little evidence on adequate doses of exercise in older people, especially in those with multimorbidity. Our main aim was to evaluate the effect of a 6-week intervention on health-related outcomes (body composition, hemodynamic and functionality changes) in 24 individuals aged 65 and older with multimorbidity in a randomized controlled trial. The intervention consisted of a very low volume (60 min per week) of low-to-moderate intensity exercise training (perception of effort from 3 to 6 on an 11-point scale). After the intervention, blood pressure was significantly ( p  = 0.038) reduced in the exercise group (EG), with a higher reduction in men. Furthermore, the EG decreased their waist circumference ( p  = 0.005), a proxy of abdominal adiposity, and demonstrated an increased likelihood (73%) that a randomly selected change in muscle mass score from the EG would be greater than a randomly selected change score from the control group. The exercise intervention was particularly effective in enhancing the functionality of older adults with multimorbidity, especially in walking speed and balance skills. Perceptually regulated intensity during exercise training seemed to be a very interesting strategy to train individuals with low physical fitness and comorbidities. This study is registered with Clinicaltrials.gov (NCT 04842396).

Background Frailty is a multidimensional clinical geriatric syndrome that may be reversed in its early stages. Most studies have paid attention to its physical or phenotypic boundaries, however, little is known about the social aspects surrounding this geriatric syndrome. The study examined the relationship between socio-demographic factors, social resources, quality of life and frailty in older adults. Methods This cross-sectional study included a representative sample ( n  = 749) of adults aged ≥65 years enrolled in forty-three senior centers located in North-West Spain. Socio-demographic data, social resources by the Older Americans Resources and Services Scale, quality of life by the World Health Organization’s Quality of Life measure-brief version (WHOQOL-BREF), and frailty status diagnosed by the Frailty phenotype were measured. Results Female gender, age older than 75 years, single marital status, a poor quality of life, and low scores in the physical health domain of the WHOQOL-BREF were the main determinants of being non-robust. Together, these variables explained 24.4% of the variance. Age between 80 and 89 years, and a poor quality of life were the main determinants for non-robust men, whilst the physical health domain of the WHOQOL-BREF was the single main determinant for women. Conclusions Our study found evidence that physical frailty is associated with social determinants and several quality of life domains. More research on this understudied topic is needed to avoid healthcare expenditures and improve the quality of life of non-robust elders.

Physical frailty is closely associated with cognitive impairment. We aim to investigate the neuropsychological profiles of prefrail and non-frail dementia-free community-dwelling older adults using a comprehensive neuropsychological evaluation, and to examine the association between specific frailty criteria and clinical and neuropsychological scores. Participants completed a comprehensive standardized neuropsychological evaluation (covering cognitive domains such as memory, executive functions, language and attention), and frailty assessment. Frailty was assessed according to biological criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. The sample comprised 60 dementia-free community-dwelling adults, aged 65 years or older (range 65–89 years; 60.0% women). Forty-two participants were classified as robust (no frailty criteria present), and 18 as prefrail (1 or 2 frailty criteria present). We explored neurocognitive differences between the groups and examined the association between specific criteria of frailty phenotype and clinical and neuropsychological outcomes with bivariate tests and multivariate models. Prefrail participants showed poorer cognitive performance than non-frail participants in both memory and non-memory cognitive domains. However, delayed episodic memory was the only cognitive subdomain that remained significant after controlling for age, gender, and educational level. Gait speed was significantly associated with general cognitive performance, immediate memory, and processing speed, while grip strength was associated with visual episodic memory and visuoconstructive abilities. Both gait speed and grip strength were negatively associated with depressive scores. Our results suggest that prefrailty is associated with cognitive dysfunction. The fact that specific cognitive domains may be susceptible to subclinical states of physical frailty may have important clinical implications. Indeed, early detection of specific cognitive dysfunctions may allow opportunities for reversibility.

Background/aims It has been shown that cognitive training might help to protect against age-related cognitive decline. Our aim was to evaluate the efficacy of a computerized cognitive training application and its near transfer effects on the cognitive status of older adults. Methods Performance on the 7-Minute Screen at baseline and at the end of the program was analyzed by using a pre-post design. Adults aged 55 and older ( n  = 101; mean age ± standard deviation: 68.97 ± 5.81 years) with and without memory impairments were trained. Results Significant improvements after the training program were found in memory, visuo-spatial and verbal fluency abilities, regardless of age, gender or education. Moreover, participants without significant memory impairments and those with Age-Associated Memory Impairment gained from the program more than subjects with mild cognitive impairment. Conclusion Computerized cognitive training programs, such as Telecognitio ® , may be used as a practical and valuable tool in clinic to improve cognitive status.

Background/Objectives: Malnutrition is a very common condition among older people and strongly affects their quality of life. The current literature relates the presence of nutritional deficiencies to several health-related factors that usually emerge at advanced stages of life. This study aimed to assess the associations between malnutrition and its determinants in a group of institutionalized older people via the Mini Nutritional Assessment–Short Form (MNA-SF) and the full MNA. Methods: The MNA-SF was compared with the full MNA to evaluate the nutritional status of 207 older people. A multinomial logistic regression analysis was performed. Results: The data revealed that institutionalized older people with cognitive impairment, frailty syndrome, dysphagia, a low BMI, a high duration of institutionalization, and a low educational level are more likely to be malnourished or at risk of malnutrition. Conclusions: The results reveal that the MNA or MNA-SF may not identify common determinants of malnutrition or nutritional risk. The identified determinants depend on the test. Therefore, the data obtained determine the need to use adequate nutritional screening tools to control the presence of malnutrition. Nutritional screening is essential to decrease public costs, hospitalizations, rates of disability, dependence, morbidity, and even mortality among institutionalized older people.

Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.

Malnutrition is a common and relevant syndrome in elderly people due to its influence on quality of life. The main aim of the present study was to identify health determinants of malnutrition or risk of malnutrition. Cross-sectional study collecting information on sociodemographic and health factors (co-morbidity, cognitive or affective problems, prescription medication use, frailty status, self-rated health) as determinants of nutritional status, assessed by the short form of the Mini Nutritional Assessment. Forty-three senior centres from Galicia (north-western Spain) participated to recruit participants. A representative community-dwelling sample of 749 elderly people aged ≥65 years. Of the total participants, 14·3 % were malnourished/at risk of malnutrition. Presence of overweight or obesity, depressive symptoms, polypharmacy (use of five or more prescription medications), presence of pre-frailty or frailty status and poor self-rated health showed the strongest relationship to malnutrition/risk of malnutrition. This model predicted 86·0 % of the cases correctly. The best determinants for women were polypharmacy and poor self-rated health, reaching 82·8 % of cases of malnourishment/risk of malnutrition predicted correctly. In men, the main determinants were overweight or obesity, depressive symptomatology and polypharmacy, with 89·8 % of cases of malnourishmen/risk of malnutrition predicted correctly. Screening for nutritional status and its determinant factors should be included as part of comprehensive assessments to ensure an early screening of malnutrition and to propose possible intervention strategies that would be important for both elderly people and the health-care system.

Nannochloropsis sp. was grown semicontinuously with a rate of daily renewal of the culture media of 40% of the volume of the culture under different irradiances (40, 60, 80, 220 and 480 μmol quanta m^sup -2^ s^sup -1^). Under the conditions tested, light saturation was achieved at 220 μmol quanta m^sup -2^ s^sup -1^ with no significant increase in steady-state cell density or of dry weight productivity with higher irradiance, reaching values of 115 × 10^sup 6^ cells ml^sup -1^ and 375 mg l^sup -1^ day^sup -1^ respectively. C/N ratios clearly indicated the point of light saturation, decreasing with increasing irradiance for light-limited conditions and increasing for light-saturated conditions. Under light-limited conditions, an increase in the irradiance produced an increase in the protein percentage of the organic fraction to the detriment of lipids and carbohydrates, while small changes were recorded under light-saturated conditions. The degree of unsaturation of fatty acids was lower with increasing irradiance, with a three-fold decrease of the percentage of total n-3 fatty acids, from 29 to 8% of total fatty acids, caused mainly by a decrease of eicosapentaenoic acid (EPA) (20:5n-3). The microalga reached its maximal value of dry weight productivity (375 mg l^sup -1^ day^sup -1^), EPA productivity (3.2 mg l^sup -1^ day^sup -1^) and maximal protein content (36% of the organic content) at the point at which light saturation was achieved. Results demonstrate the efficiency of the use of the irradiance for the modification of the biochemical composition of Nannochloropsis sp.[PUBLICATION ABSTRACT]