Target

Interventions

Cognitive health

Maintain cognitive health by addressing:

1) Hearing and vision impairment

2) Sleep, with a target of 7-8 h/night

3) Social isolation: Family, friends, and community groups

4) Diet and exercise (see below)

Medication review

Optimize appropriate use of medications in older adults using:

1) START/STOPP criteria (www.valeofyorkccg.nhs.uk or www.mm.wirral.nhs.uk)

2) Beers Criteria (www.pharmacytoday.org)

3) Deprescribing.org resources (www.deprescribing.org)

Diet and exercise

Address physical sarcopenia (defined as the presence of low skeletal muscle mass and low muscle strength):

1) Exercise: Community exercise program that includes a resistance-based training componenta

2) Protein supplementationb and nutrition education (consider community meal programs such as Meals-on-Wheels)

3) Vitamin D supplementation if deficiency is present

^a Exact combination of aerobic, resistance, and/or balance training is unclear.

^b Optimal total daily protein intake (dietary plus supplemental protein) is 1.2 to 1.5 g of protein/kg of body weight.