In this research update, Kathryn Waldegrave, lecturer in community nursing at the University of Leeds, writes about the exacerbation of frailty symptoms in the absence of adequate vitamin intake.
Frailty is a long term condition, a geriatric syndrome in which age-related musculoskeletal changes are evident and where a loss of functional reserves may cause vulnerability in dealing with health stressors. Early identification can enable appropriate interventions to support a reversing of frailty symptoms, and achieving optimum nutrition is one example. One underexplored aspect of nutrition in relation to frailty is the importance of vitamin intake and the challenges that present when considering the age-related physiological alterations which occur to the gastrointestinal tract coupled with appetite changes. Such issues can inhibit uptake and absorption of vitamins, which may lead to malnourishment or deficiency and worsening of frailty symptoms.
A study in Spain sought to assess the association between vitamin intake and frailty prevalence by analysing data from the Seniors-ENRICA cohort study. The sample featured 1,643 community-dwelling adults aged 65 and over. It excluded older adults already taking vitamin supplements alongside those with existing frailty or extremes of dietary intake. Sociodemographic data was collected via telephone interviews, followed by assessments and dietary intake validation through home visits over a follow up period of approximately 2.5 years.
Respondents reporting three or more points from a 5-point, predetermined criteria were classified as frail. Findings indicated 89 (5.4%) of the respondents developed frailty symptoms over this time period, the majority being female with a high body mass index and lower intake of the 10 evaluated vitamins.
A commentary highlights that not all data analysed showed statistically significant results, but that in not meeting the recommended daily intake of five or more vitamins, the risk of frailty was increased. Rather than highlighting the benefits of any particular vitamin, the study advocates the importance of a nutritionally well balanced diet to promote health and reduce the risk of developing frailty symptoms. The commentary acknowledges that health professionals hold a pivotal role in identifying nutritional deficiency; whilst there are numerous screening and assessment tools currently used in clinical practice, incorporating basic questions relating to dietary intake as part of a nursing assessment would highlight any areas of concern and enable appropriate strategies to be implemented.
Reference: Balboa-Castillo T, Struijk E, Lopez-Garcia E, Banegas J, et al. Low vitamin intake is associated with risk of frailty in older adults. Age Ageing 2018; 47:872-879
Commentary: Fletcher J. Low intake of vitamins B6, C, E and folate from dietary sources may lead to a higher risk of developing frailty in older adults. Evid Based Nurs 2019, online first 28 May
Kathryn Waldegrave is a lecturer in community nursing at the University of Leeds