Original Study| Volume 17, ISSUE 7, P671.e9-671.e16, July 01, 2016

Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial



      The aim of this study was to examine the effects of a home-based and volunteer-administered physical training and nutritional intervention program compared with social support intervention on nutritional and frailty status in prefrail and frail community-dwelling older persons.


      This was a randomized controlled trial in which community-dwelling persons (mean age = 83 years) were recruited and randomly assigned to the physical training and nutritional intervention group (PTN, n = 39) and the social support group (SoSu, n = 41). The study was conducted by trained lay nonprofessionals.


      The community-dwelling older persons in both groups were visited twice a week by trained nonprofessional volunteers (buddies) in Vienna, Austria.


      Eighty prefrail and frail adults aged 65 years or older.


      In the PTN group, both the buddies and older persons performed 6 strength exercises within a circuit training session and discussed nutrition-related aspects. The active control group (SoSu) had the opportunity to perform cognitive training in addition to the social contact.


      Outcome measures as nutritional (Mini Nutritional Assessment long form [MNA-LF]) and frailty status (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe [SHARE-FI]) were obtained at baseline and after 12 weeks.


      Significant improvements in the MNA-LF score (1.54 points, 95% confidence interval [CI] 0.51–2.56; P = .004) and the SHARE-FI score (−0.71 discrete factor score values, 95% CI −1.07, −0.35; P < .001) were observed in the PTN group after 12 weeks. In both groups, the prevalence of impaired nutritional status and frailty decreased significantly over time. The prevalence of impaired nutritional status decreased by 25% in the PTN group and by 23% in the SoSu group. Moreover, the prevalence of frailty decreased by 17% in the PTN group and by 16% in the SoSu group. The presence of impaired nutritional status at baseline was independently associated with greater changes in the nutritional (adjusted odds ratio [OR] 3.18, 95% CI 1.26–7.98; P = .014) and frailty status (adjusted OR 3.16, 95% CI 1.01–9.93; P = .049) after 12 weeks.


      The results indicate that a home-based physical training, nutritional, and social support intervention conducted by nonprofessionals is feasible and can help to tackle malnutrition and frailty in older persons living at home. Furthermore, social support alone also can result in improvement. In particular, older adults with impaired nutritional status at baseline can benefit more from the intervention. Such a home visit program might also have the potential to prevent future health risks and could allay isolation and loneliness.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • European Commission (DG ECFIN), Economic Policy Committee (AWG)
        The 2012 Ageing Report: Economic and budgetary projections for the 27 EU Member States (2010–2060).
        European Economy. 2012; 2: 12
        • Farre T.B.
        • Formiga F.
        • Ferrer A.
        • et al.
        Risk of being undernourished in a cohort of community-dwelling 85-year-olds: The Octabaix study.
        Geriatr Gerontol Int. 2014; 14: 702-709
        • Allison S.P.
        Malnutrition, disease, and outcome.
        Nutrition. 2000; 16: 590-593
        • Dorner T.E.
        • Schwarz F.
        • Kranz A.
        • et al.
        Body mass index and the risk of infections in institutionalised geriatric patients.
        Br J Nutr. 2010; 103: 1830-1835
        • Locher J.L.
        • Roth D.L.
        • Ritchie C.S.
        • et al.
        Body mass index, weight loss, and mortality in community-dwelling older adults.
        J Gerontol A Biol Sci Med Sci. 2007; 62: 1389-1392
        • Inzitari M.
        • Doets E.
        • Bartali B.
        • et al.
        Nutrition in the age-related disablement process.
        J Nutr Health Aging. 2011; 15: 599-604
        • Chevalier S.
        • Saoud F.
        • Gray-Donald K.
        • et al.
        The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status.
        J Nutr Health Aging. 2008; 12: 721-726
        • Lee L.C.
        • Tsai A.C.
        Mini-Nutritional Assessment predicts functional decline of elderly Taiwanese: result of a population-representative sample.
        Br J Nutr. 2012; 107: 1707-1713
        • Zuliani G.
        • Romagnoni F.
        • Volpato S.
        • et al.
        Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M212-M216
        • Espinoza S.E.
        • Fried L.P.
        Risk factors for frailty in the older adult.
        Clin Geriatr. 2007; 15: 37-44
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: Evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Fried L.
        • Walston J.
        • Ferrucci L.
        in: Hazzard W. Halter J. Hazzard's Geriatric Medicine and Gerontology. McGraw-Hill Medical, New York2009: 631-645
        • Papiol M.
        • Serra-Prat M.
        • Vico J.
        • et al.
        Poor muscle strength and low physical activity are the most prevalent frailty components in community-dwelling older adults.
        J Aging Phys Act. 2015;
        • Dorner T.E.
        • Luger E.
        • Tschinderle J.
        • et al.
        Association between nutritional status (MNA-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients.
        J Nutr Health Aging. 2014; 18: 264-269
        • Abellan Van Kan G.
        • Vellas B.
        Is the Mini Nutritional Assessment an appropriate tool to assess frailty in older adults?.
        J Nutr Health Aging. 2011; 15: 159-161
        • Bollwein J.
        • Volkert D.
        • Diekmann R.
        • et al.
        Nutritional status according to the Mini Nutritional Assessment (MNA(R)) and Frailty in community dwelling older persons: A close relationship.
        J Nutr Health Aging. 2013; 17: 351-356
        • Song X.
        • Mitnitski A.
        • Rockwood K.
        Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation.
        J Am Geriatr Soc. 2010; 58: 681-687
        • Faber M.J.
        • Bosscher R.J.
        • Chin A.P.
        • et al.
        Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial.
        Arch Phys Med Rehabil. 2006; 87: 885-896
        • Cesari M.
        • Vellas B.
        • Hsu F.C.
        • et al.
        A physical activity intervention to treat the frailty syndrome in older persons—results from the LIFE-P study.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 216-222
        • Cameron I.D.
        • Fairhall N.
        • Langron C.
        • et al.
        A multifactorial interdisciplinary intervention reduces frailty in older people: Randomized trial.
        BMC Med. 2013; 11: 65
        • Ng T.P.
        • Feng L.
        • Nyunt M.S.
        • et al.
        Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: A randomized controlled trial.
        Am J Med. 2015; 128: 1225-1236.e1
        • Chan D.C.
        • Tsou H.H.
        • Yang R.S.
        • et al.
        A pilot randomized controlled trial to improve geriatric frailty.
        BMC Geriatr. 2012; 12: 58
        • Latham N.K.
        • Anderson C.S.
        • Lee A.
        • et al.
        A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: The Frailty Interventions Trial in Elderly Subjects (FITNESS).
        J Am Geriatr Soc. 2003; 51: 291-299
        • Chin A.P.M.J.
        • de Jong N.
        • Schouten E.G.
        • et al.
        Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: A randomized controlled trial.
        Arch Phys Med Rehabil. 2001; 82: 811-817
        • Niemela K.
        • Leinonen R.
        • Laukkanen P.
        A supportive home visit program for older adults implemented by non-professionals: Feasibility and effects on physical performance and quality of life at one year—a pilot study.
        Arch Gerontol Geriatr. 2012; 54: e376-e382
        • Kahn E.B.
        • Ramsey L.T.
        • Brownson R.C.
        • et al.
        The effectiveness of interventions to increase physical activity. A systematic review.
        Am J Prev Med. 2002; 22: 73-107
        • Carmody T.P.
        Health related behaviours: Common factors.
        in: Ayers S. Baum A. McManus C. Cambridge Handbook of Psychology Health and Medicine. Cambridge University Press, Cambridge, England1997: 117-121
        • Dorner T.E.
        • Lackinger C.
        • Haider S.
        • et al.
        Nutritional intervention and physical training in malnourished frail community-dwelling elderly persons carried out by trained lay “buddies”: study protocol of a randomized controlled trial.
        BMC Public Health. 2013; 13: 1232
        • Guigoz Y.
        • Vellas B.
        • Garry P.J.
        Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation.
        Nutr Rev. 1996; 54: S59-S65
        • Romero-Ortuno R.
        • Walsh C.D.
        • Lawlor B.A.
        • et al.
        A frailty instrument for primary care: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE).
        BMC Geriatr. 2010; 10: 57
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Kessler J.
        • Denzler P.
        • Markowitsch H.J.
        Mini Mental Status Examination MMSE. German Version. DT Demenz-Test: Eine Testbatterie zur Erfassung kognitiver Beeinträchtigungen im Alter.
        Beltz-Verlag, Weinheim1990
        • Dale O.
        • Salo M.
        The Helsinki Declaration, research guidelines and regulations: present and future editorial aspects.
        Acta Anaesthesiol Scand. 1996; 40: 771-772
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials.
        Int J Surg. 2011; 9: 672-677
        • Dorner T.E.
        • Tschinderle J.
        • Schindler K.
        Frailty, Ernährungsstatus und Bereitschaft zu einer Trainings—und Ernährungsintervention bei älteren Personen in Wiener Krankenhäusern.
        Wien Klin Wochenschr. 2011; 123: A40-A41
      1. Web-based patient randomization service for multi-center clinical trials 1.8.1. Available at: Accessed September 12, 2013.

      2. Harvard University. Healthy eating plate. Available at: Accessed October 4, 2013.

        • Vellas B.
        • Guigoz Y.
        • Garry P.J.
        • et al.
        The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.
        Nutrition. 1999; 15: 116-122
        • Rubenstein L.Z.
        • Harker J.O.
        • Salva A.
        • et al.
        Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF).
        J Gerontol A Biol Sci Med Sci. 2001; 56: M366-M372
        • Roberts H.C.
        • Denison H.J.
        • Martin H.J.
        • et al.
        A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach.
        Age Ageing. 2011; 40: 423-429
        • Cederholm T.
        • Bosaeus I.
        • Barazzoni R.
        • et al.
        Diagnostic criteria for malnutrition—An ESPEN consensus statement.
        Clin Nutr. 2015; 34: 335-340
        • Hollis S.
        • Campbell F.
        What is meant by intention to treat analysis? Survey of published randomised controlled trials.
        BMJ. 1999; 319: 670-674
        • Bursac Z.
        • Gauss C.H.
        • Williams D.K.
        • et al.
        Purposeful selection of variables in logistic regression.
        Source Code Biol Med. 2008; 3: 17
        • Zhang S.
        • Paul J.
        • Nantha-Aree M.
        • et al.
        Empirical comparison of four baseline covariate adjustment methods in analysis of continuous outcomes in randomized controlled trials.
        Clin Epidemiol. 2014; 6: 227-235
        • Bandayrel K.
        • Wong S.
        Systematic literature review of randomized control trials assessing the effectiveness of nutrition interventions in community-dwelling older adults.
        J Nutr Educ Behav. 2011; 43: 251-262
        • Milne A.C.
        • Potter J.
        • Vivanti A.
        • et al.
        Protein and energy supplementation in elderly people at risk from malnutrition.
        Cochrane Database Syst Rev. 2009; : CD003288
        • Payette H.
        • Boutier V.
        • Coulombe C.
        • et al.
        Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: A prospective randomized community trial.
        J Am Diet Assoc. 2002; 102: 1088-1095
        • Smoliner C.
        • Norman K.
        • Scheufele R.
        • et al.
        Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition.
        Nutrition. 2008; 24: 1139-1144
        • Tieland M.
        • Borgonjen-Van den Berg K.J.
        • van Loon L.J.
        • et al.
        Dietary protein intake in community-dwelling, frail, and institutionalized elderly people: Scope for improvement.
        Eur J Nutr. 2012; 51: 173-179
        • Shekelle P.G.
        • Maglione M.
        • Mojica W.
        • et al.
        Exercise Programs for Older Adults: A Systematic Review and Meta-analysis.
        RAND Corporation, RP-1257, Santa Monica, CA2003 (Available at: Accessed March 21, 2016)
        • Orr R.
        • Raymond J.
        • Fiatarone Singh M.
        Efficacy of progressive resistance training on balance performance in older adults: A systematic review of randomized controlled trials.
        Sports Med. 2008; 38: 317-343
        • Gine-Garriga M.
        • Roque-Figuls M.
        • Coll-Planas L.
        • et al.
        Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: A systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2014; 95: 753-769.e3
        • Chou C.H.
        • Hwang C.L.
        • Wu Y.T.
        Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis.
        Arch Phys Med Rehabil. 2012; 93: 237-244
        • Kwon J.
        • Yoshida Y.
        • Yoshida H.
        • et al.
        Effects of a combined physical training and nutrition intervention on physical performance and health-related quality of life in prefrail older women living in the community: A randomized controlled trial.
        J Am Med Dir Assoc. 2015; 16: 263.e1-263.e8
        • Nykanen I.
        • Rissanen T.H.
        • Sulkava R.
        • et al.
        Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on nutritional status: A population-based intervention study.
        J Nutr Health Aging. 2014; 18: 54-58
        • Badia T.
        • Formiga F.
        • Ferrer A.
        • et al.
        Multifactorial assessment and targeted intervention in nutritional status among the older adults: A randomized controlled trial: The Octabaix study.
        BMC Geriatr. 2015; 15: 45
        • Fairhall N.
        • Sherrington C.
        • Kurrle S.E.
        • et al.
        Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: Randomised controlled trial.
        BMC Medicine. 2012; 10: 1-13
        • Clegg A.
        • Young J.
        • Iliffe S.
        • et al.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Fairhall N.
        • Langron C.
        • Sherrington C.
        • et al.
        Treating frailty—a practical guide.
        BMC Med. 2011; 9: 83