Geriatric PTs: Prevent Frailty with Diet

By Dr. Sean M. Wells, DPT, PT, OCS, CNPT, ATC/L, CSCS, NSCA-CPT, Cert-DN

Most physical therapists (PTs) that work with older adults know the importance of preventing their clients from reaching frailty. From falls, femur fractures, to loss of function, frailty can mean a significant change in the quality of life but also potentially earlier death. Doctors of Physical Therapy (DPT) offer older clients an array of treatments from strength exercises, therapeutic activities, balance programs, and functional exercise to mitigate the effects of frailty. But what if we could do more to help our older patients?

New research out of Harvard, and published in the Journal of Gerontology, demonstrates that diet plays a key role in the development of not only frailty but also depression in older adults. The Framingham Heart Study Offspring cohort provided the data used in the study, which include 1,701 non-frail individuals who provided information on their diet and depressive symptoms at the start of the study. They were followed for about 11 years when frailty status was reassessed. Not surprisingly, the researchers found a link between an inflammatory diet and an elevated risk of frailty, which was somewhat greater among individuals with depressive symptoms.

Another key finding was that an inflammatory diet in older adults with depressive symptoms might hasten the onset of frailty. The exact mechanism of this connection is not fully understood, but the researchers suggested that the inflammation may affect the gut biome and/or the brain's ability to remove inflammatory wastes. Regardless, worsening depression in older adults is not a positive thing. As PTs we understand how depression can rob our clients of performing activities, engaging socially, and the deleterious impacts of these withdrawal behaviors.

The important question remains: what did the inflammatory diet consist of? The authors cited most of the foods were considered ultra-processed foods that were rich in saturated fats, refined carbohydrates, and low in fruits and vegetables. Such a diet includes:

French fries, potato chips, and other fried foods
Cakes, donuts, and pies
Processed meats, burgers, and milkshakes
Candy, white bread, and pastries

Researchers in the study point to the importance of consuming a mostly plant-based diet, like the true Mediterranean diet. Such a diet is low in the above foods and rich in flavanoids, which can prevent fraility. So in the end, DPTs need to step up there game! It's time for us to start talking with our older clients about their dietary patterns. Use simple tools like fruit and vegetables screens, mini-nutritional assessment to screen for malnutrition, and refer our older adults to registered dieticians so they can formulate a meal plan that focuses on health plant food, not ultra-processed junk.

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