Nutrition and Physical Activity Clinical Practice Guidelines for Older Adults Living with Frailty.

BACKGROUND: We developed clinical practice guidelines to provide health care providers with evidence-based recommendations for decisions related to the effective management of frailty and pre-frailty using nutrition and physical activity interventions. METHODS: We based the recommendations on two systematic reviews with meta-analyses. Nutrition, physical activity, and combined nutrition and physical activity interventions for adults ≥65y were considered if study populations were identified as frail using a frailty tool or assessment. Risk of bias and certainty of evidence were evaluated. We included physical outcomes, mobility, frailty, cognitive function, activities of daily living, falls, quality of life, diet quality, energy/fatigue levels, health services use, and caregiver outcomes. RESULTS: Overall, mobility improvements were moderate with nutritional strategies that optimize dietary intake, various types of physical activity interventions, and interventions that combine nutrition and physical activity. Physical outcomes, such as body mass and muscle strength, improved moderately with nutritional strategies and interventions that combined nutrition with physical activity. Frailty status improved with multi-component physical activity interventions. Strong recommendations include optimizing dietary intake, performing physical activity, and adopting interventions that combine nutrition and physical activity. We strongly recommend various types of physical activity including muscle strengthening activities, mobilization or rehabilitation exercises, and multi-component physical activity interventions. INTERPRETATION: Tailored nutrition and physical activity interventions based on individual goals and health status are associated with improved clinical and physical outcomes. While the recommendations facilitate shared decision-making, we identified sparse application of validated frailty assessments and lack of standardized research outcomes as critical gaps in knowledge.

Challenges of glaucoma service delivery in Federal Medical Centre, Azare, Nigeria.

To find out the challenges of management of glaucoma, an assessment of glaucoma services at the Federal Medical Centre, Azare was carried out through oral interviews of ophthalmic staff, enquiring about available personnel and diagnostic equipment from relevant sectors of the Hospital and local authorities. A retrospective analysis of records of glaucoma patients (aged > 20 years) who presented at the centre between February 2002 and July 2007 was carried out. The ophthalmology unit has 6 ophthalmic nurses, 1 ophthalmologist and 1 optometrist. Instruments available were: A Schiotz tonometer, a slit lamp biomicroscope, a Volk +90 Diopter lens, a Goldman applanation tonometer, a l-mirror gonioscopy lens, a non contact applantation tonometer and a visual field analyzer. All the patients treated conservatively had guttae timolol 0.5% either solely (64 eyes, 50.8%) or in combination with other intraocular pressure lowering eye drops. Only one patient was treated with guttae latanoprost 0.005% (Xalatan). The only type of surgery carried out was Trabeculectomy in 22 eyes (14.0%). No intra or post operative antifibrotic agent was used. There is a dire need of human and infrastructural facilities for adequate management of glaucoma in the centre.