Yuka Shirai

Objective: Frailty is a significant health problem that results in adverse outcomes, reduced quality of life, and increased medical and nursing care costs. This study aimed to review the effect of digital health interventions on improving physical activity, physical function, and social function in non-older individuals at risk of frailty. Methods: Randomized controlled trials of digital health interventions reporting frailty-related outcomes on physical activity, physical function, and social function in non-older individuals at risk of frailty were collected. The literature was reviewed, and the risk of bias was assessed. Meta-analyses were conducted for each outcome, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Results: The review included a total of 63 records. The meta-analysis showed that digital health interventions positively affected the volume of physical activity, daily steps, walking test, walking speed, VO2peak, dynamic gait index, timed up and go test, and MOS 36-Item Short-Form Health Survey Social Functioning. However, no significant effect on the time of physical activity was found. Despite the absence of fatal bias, the overall certainty of the evidence was not high because of the small number of studies and participants included in the analysis. Conclusions: Digital health interventions can improve physical activity, physical function, and social function in non-older individuals at risk of frailty. However, the evidence had limited certainty, and the evidence supporting the effect of digital health intervention is insufficient. Thus, more studies are needed to clarify the effects of these interventions.

Aim: This study aimed to investigate the associations between bed‐rest time and food intake and between bed‐rest time and constipation in older nursing home residents.Methods: We conducted a cross‐sectional study using data from the Long‐term Care Information System for Evidence (LIFE) database. We used data collected from older nursing home residents registered in the LIFE database between April 2022 and March 2023. We compared outcome data between the short‐bed‐rest group (≥9 h out of bed per day) and the long‐bed‐rest group (P < 0.001), the percentage of energy sufficiency (standardized coefficient 0.30, p < 0.001), and incidence of constipation (odds ratio: 0.12, P < 0.001).Conclusion: Bed‐rest time is associated with food intake and constipation in older nursing home residents. Geriatr Gerontol Int 2025; 25: 583–587.

Frailty, sarcopenia, and malnutrition are highly prevalent among the older population

Malnutrition prevails among patients with heart failure (HF), increasing the likelihood of functional decline. We assessed the predictive value of the Hemoglobin-Geriatric Nutritional Risk Index (H-GNRI)—combining hemoglobin and the Geriatric Nutritional Risk Index (GNRI)—on prognosis in older patients with HF. We used the JMDC multicenter database to examine the potential associations between malnutrition risk and other outcome measures. The patients were categorized as low- (H-GNRI score = 2), intermediate- (H-GNRI score = 1), or high-risk (H-GNRI score = 0) based on their H-GNRI scores. The primary outcome measure was the Barthel Index (BI) gain; the secondary outcomes included the BI at discharge, the BI efficiency, length of hospital stay, in-hospital mortality, discharge to home or a nursing home, and hospitalization-associated disability. We analyzed 3532 patients, with 244 being low-risk, 952 being intermediate-risk, and 2336 being high-risk patients. The high-risk group of patients had significantly lower BI values at discharge, lower BI gains, reduced BI efficiency values, and prolonged hospital stays compared to those in the low-risk group. The high-risk patients also had higher in-hospital mortality rates, lower rates of discharge to home or a nursing home, and greater incidences of a hospitalization-associated disability in comparison to the low-risk group. The H-GNRI may serve as a valuable tool for determining prognoses for patients with HF.

Malnutrition is a common complication in patients undergoing rehabilitation

Low body mass index (BMI) is an independent predictor of prolonged hospital stay and mortality in patients with chronic obstructive pulmonary disease (COPD). However, to the best of our knowledge, no studies have examined the validity of Asian BMI cutoff values for classifying severity based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with acute COPD exacerbations. This study sought to validate whether Asian BMI cutoff values can accurately predict 30-day in-hospital mortality, length of stay, and 90-day readmission outcomes for patients with acute COPD exacerbations. The present retrospective cohort study was conducted using a large claims database created by the JMDC. Patients were classified into three groups according to the severity of low BMI assessed using Asian BMI cutoff values. As a result, 624 (29.4%) had severely low BMI, and 444 (20.9%) had moderately low BMI. The severity of low BMI, as assessed by the Asian BMI cutoff values used in the GLIM criteria, was independently associated with 30-day in-hospital mortality (moderately low BMI: HR, 1.87; 95% CI, 1.13–3.08; p = 0.014 and severely low BMI: HR, 2.55; 95% CI, 1.66–3.92; p < 0.001). The Asian BMI cutoff values used to classify the severity of malnutrition in the GLIM criteria are clinically functional for predicting the prognosis of patients with acute COPD exacerbations.

Malnutrition negatively affects the quality of life of patients with dysphagia. Despite the need for nutritional status assessment in patients with dysphagia, standard, effective nutritional assessments are not yet available, and the identification of optimal nutritional assessment items for patients with dysphagia is inadequate. We conducted a scoping review of the use of nutritional assessment items in adult patients with oropharyngeal and esophageal dysphagia. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched to identify articles published in English within the last 30 years. Twenty-two studies met the inclusion criteria. Seven nutritional assessment categories were identified: body mass index (BMI), nutritional screening tool, anthropometric measurements, body composition, dietary assessment, blood biomarkers, and other. BMI and albumin were more commonly assessed in adults. The Global Leadership Initiative on Malnutrition (GLIM), defining new diagnostic criteria for malnutrition, includes the categories of BMI, nutritional screening tool, anthropometric measurements, body composition, and dietary assessment as its required components, but not the blood biomarkers and the “other” categories. We recommend assessing nutritional status, including GLIM criteria, in adult patients with dysphagia. This would standardize nutritional assessments in patients with dysphagia and allow future global comparisons of the prevalence and outcomes of malnutrition, as well as of appropriate interventions.