Outline of Today s Session:

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2 Outline of Today s Session: CGS Special Interest Group on Nutrition Special introduction by Dr. José Morais Increasing evidence for frailty decision making John Muscedere, MD, FRCPC, Canadian Frailty Network Scientific Director Nutrition as a treatment strategy for frailty Heather Keller, RD, PhD, Schlegel University of Waterloo Research Institute for Aging The potential for functional foods to prevent frailty Alison Duncan, RD, PhD, University of Guelph 2

3 Learning Objectives After this session participants will be able to: Describe the proposed mechanisms for malnutrition and frailty. Understand the evidence for the ability of nutrition, including functional foods to prevent frailty. Understand how nutritional intake of older adults who are pre frail or frail can be improved. 3

4 Frailty in Canadians

5 What is CFN? National non profit network funded by Networks of Centres of Excellence to develop, evaluate and disseminate knowledge on health care for older Canadians living with frailty All settings spanning from home/community care to acute/critical care including transitions of care, and end of life care and advance care planning. Launched in July 2012; renewed in 2017 potential for renewal until 2027

6 CFN s Mission is: To improve care for older adults living with frailty: We do this by increasing recognition and assessment of frailty, by increasing evidence for decision making, by advance evidence based changes to care, by educating the next generation of care providers, and by engaging with older adults and caregivers. Spheres of Activity 1. Research Fund original, patient centred research 2. Training Program Next generation of scientists and care professionals 3. Knowledge Mobilization Dissemination, Implementation 4. Networking and Partnerships Domestic and International 6

7 Need for Evidence 7

8 The Problem Lack of Evidence (1) Care providers and decision makers often face difficult decisions when treating older adults living with frailty but high quality evidence for decision making is often lacking Evidence is lacking because: The frail/those with significant comorbidities are often excluded from trials Trials enrolling older adults rarely consider differential impact of frailty Few frailty clinical trials Questions: Similar risks/benefits? Applicability or generalizability of evidence?

9 The Problem Lack of Evidence (2) Because of the lack of evidence: Treatments that are effective in fit patients are often applied to those with frailty May not be effective and result in harm or wasted resources Expensive technologies are often aggressively used on frail patients without improvement in outcomes Possibility that therapies/interventions not effective in fit patients may actually be effective in those who are frail

10 Publications/Year Source: PubMed Frailty Publications Per Year

11 Systematic Review of RCTs studying the impact of an intervention on a frail population (n = 202) System Organization Pharmaceutical Nutrition and Exercise Miscellanous Geriatric Assessment Multifaceted Intervention Nutrition Rehabilatation Tai chi Transfusions Fall Prevention Medication Prescription Hip Protector Exercise 51 (26%) 33 (17%) 29 (15%) 19 (10%) 18 (9%) 16 (8%) 9 (4%) 8 (4%) 7 (3%) 3 (1%) 3 (1%) 3 (1%) 2 2 (1%) (1%) Number of Studies 11

12 Thank You! Questions?

13 Nutrition projects Acute/Critical Care More 2 Eat: Nutrition care pathway and optimized protein supplementation for malnourished elderly patients. Heather Keller and Adam Rahman. Nutrition Care Pathway for Hospitalized Older Adults: Content validation and feasibility testing. Heather Keller Knowledge Translation Grant : More 2 Eat Phase 2: spread/scaling up improved nutrition care to detect and treat hospital malnutrition. Heather Keller Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT): A Feasibility Pilot Trial. Deborah Cook. 13

14 Exercise projects Exercise Studies Acute/Critical Care E CYCLE: A pilot randomized clinical trial of early in bed cycling in elderly, mechanically ventilated patients. Michelle Kho Optimizing Community Care/ Residential Care The Jintronix technology to prevent functional decline in pre frail/frail seniors consulting Emergency Departments. Marcel Emond An ounce of prevention: intensive resistance training to optimize health in pre frail older adults. Ada Tang Rehabilitation for the seriously ill elderly: models of care and quality indicators. Lora Giangregorio Connecting Emergency Departments with Community services to prevent mobility losses in pre frail & frail Seniors (CEDeComS) pre implementation. Marcel Emond Interventions to prevent and treat frailty in community dwelling older adults: a scoping review of the literature and international policies. Martine Puts 14

15 Summary of first term research activity Investment in 88 research projects during our first term 121 Principal Investigators, 421 Co investigators Catalyzed approx. $30 Mil. total research funding ($13 Mil. from CFN + $7 Mil. partner contributions + $10 Mil add on from other agencies) 57 Interventional studies Number of research projects EOL Care/ACP 27 Acute Care/Critical Care 35 Community/ Residential Care *Numbers add up to greater than 88 since some grants covered more than one theme 22 Transitions of Care 15