Development and effects of an intervention module and educational materials to prevent frailty syndrome through nutrition education and exercise among Malaysian elderly

Frailty syndrome prevention is critical in geriatrics due to its high prevalence (prefrail: 57.9 to 72.8%; frail: 5.9 - 56.5%) and its adverse health impacts on older adults. Prevalence is notably higher among low-income individuals, emphasizing the need for effective, targeted interventions in this vulnerable group. This study examined the effects of a nutrition education and exercise intervention by developing, implementing, and evaluating an intervention module and educational materials aimed at preventing frailty among prefrail and frail older adults in PPR flats in Kuala Lumpur, Malaysia. The study consisted of two phases. Phase I involved developing a frailty intervention module and educational materials, including a booklet, flipchart, and slides presentation. The final products were tested for acceptance among nine health professionals in the Klang Valley area and 16 older adults from PPR Hiliran Ampang. The materials were highly rated for understandability (84.9%-97.2%) and actionability (73.2%-95.2%), indicating strong acceptance by both groups. In Phase II of the study, 57 older adults completed a 12-week randomized controlled trial to assess the effects of a frailty syndrome prevention program. The intervention group received nutrition education and multicomponent exercise, while the control group received the same benefits after 24 weeks. The primary outcome is frailty score and secondary outcome include knowledge, attitude, and practice (KAP) towards frailty, nutrition and exercise, body composition, dietary intake, cognitive status, mobility, and risk of falls, at baseline, week 12, and week 24. Participants' ages ranged from 60 to 80 years, with an average age of 66.9 ± 5.0 years. Most were female (80.7%) and of Malay ethnicity (91.2%), with 73.3% classified as prefrail and 26.3% as frail. While sociodemographic characteristics were generally balanced, gender and marital status were significantly differences and were controlled during main analysis. The findings indicate that the intervention had significant effects on frailty- related measures, including improvement in handgrip strength (p = 0.025), gait speed (p = 0.003), knowledge (p = 0.001), attitude (p < 0.001), and mobility (p = 0.001). The significant of interaction effects of time and group were observed in frailty score (p < 0.001), handgrip (p = 0.016), gait speed (p < 0.001), KAP (p < 0.001; < 0.001; 0.026), and mobility (p < 0.001), indicating treatment efficacy over time. However, no significant effects were found on dietary intake, body composition, physical activity, or cognitive status, highlighting the complexity of addressing these factors within a short-term intervention. This study contributes valuable insights into the effects of nutrition education and exercise interventions on frailty-related outcomes among low-income older adults. Future research should further investigate long-term effects, explore how dietary components influence frailty prevention, and assess the scalability of the intervention for broader implementation.

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