An 87-year-old man with dementia with Lewy bodies, surviving in residential aged treatment, exhibited rapid functional fat and drop loss connected with injurious falls more than 9 weeks. as the discussion among four central elements: sarcopenia, malnutrition, atherosclerosis and cognitive impairment.2 Extrinsic elements such as for example decreased physical immobilisation and activity, insufficient diet proteins and energy intake, texture-modified diet programs as well Syk as the iatrogenic ramifications of medicines might increase pathophysiologic stressors including cachexia from chronic disease, skeletal and cardiac muscle dysfunction, sedation, apathy, depression, loneliness, delirium, psychosis, anorexia of ageing, dysphagia, poor dentition, impairment of eyesight, taste and smell. Many of these stressors exert pressure on these four crucial the different parts of frailty and so are modifiable to a differing level.2C10 Additionally, malnutrition, cognitive atherosclerosis and impairment can all exacerbate BAY 63-2521 inhibitor sarcopenia by adding to a poor energy cash, decreased drive to work out and a substantial decrease in physical capacity, respectively.11 In the residential aged treatment environment, there’s a confluence of the risk elements for frailty, producing a five-fold higher occurrence than among community-dwelling older adults.12 13 Recommendations for aged treatment services traditionally concentrate on safety/falls reduction,14 which is the leading cause of accidental death in these facilities.15 Many recommendations for falls reduction, such as deprescribing high-risk medications and offering challenging balance exercises, may improve frailty as well.14 However, a safety focus can also lead to undesirable practices such as the use of restraints and immobilising chairs, which may reduce falls risk but actively exacerbate underlying frailty; thereby leaving the individual even more vulnerable to injurious falls and adverse outcomes.16 Recently released guidelines on frailty clearly recommend anabolic interventions such as progressive resistance exercise and increased protein/energy intake as first-line treatments to prevent and treat frailty.17 Evidence for the efficacy of this approach in frail populations has been available since the 1990s18 but has not yet become routine practice within residential aged care. BAY 63-2521 inhibitor The potential for remediating frailty is significant, especially for those living with dementia, who experience the highest levels of frailty in this setting.19 Notably, the aetiology of frailty in individuals with dementia is reported to have minimal correlation with the burden of disease pathology in the brain,20 suggesting that the higher incidence of frailty cannot be attributed to normal disease course and may be related to factors more amenable to intervention. The following case provides a rare, longitudinal insight into the aetiology and progression of frailty in a patient of advanced age with an aggressive neurodegenerative disease: dementia with Lewy bodies (DLB). We highlight the critical importance of differentiating disease progression from remediable causes of frailty, and the positive outcomes of a comprehensive intervention of deprescribing, increased proteinCenergy intake and robust anabolic exercise. Case presentation An 87-year-old man diagnosed with mild DLB 1?year prior by a geriatrician and living in a residential aged care facility since diagnosis was BAY 63-2521 inhibitor screened for a pilot exercise trial.21 He satisfied both the 2005 and 2017 criteria for the analysis of possible DLB like the onset of dementia ahead of motor symptoms and the current presence of several core features: fluctuating cognition and alertness, well-formed visual hallucinations and spontaneous parkinsonism features.22 23 He resided inside a obtainable space by himself and his wife lived locally, visiting daily. He previously a recent background of repeated falls and got dropped 7% of his bodyweight in the a year since getting into the service. Health background included osteoporosis with hip fracture 5 years previous, persistent obstructive pulmonary disease (COPD), gout pain, dyslipidaemia, hypertension, macular degeneration, melancholy and a brief history of excessive alcoholic beverages usage to entrance prior. Medicines included mirtazapine, aspirin, perindopril, atorvastatin, tiotropium bromide, allopurinol and paracetamol. A texture-modified diet plan had been applied due to worries encircling dysphagia and potential aspiration. The individual was noticed to deteriorate in wellness position, precipitated by two injurious falls over 9 weeks while signed up for a wait-list control period for the workout trial. Evaluations had been conducted to recognize potential aetiologic elements in his fast functional decline. Investigations The scholarly research geriatrician and workout physiologist undertook exterior investigations during a protracted, 9-month wait-list period because of the sick health of the individual ahead of intervening. Desk 1 presents a timeline of relevant investigations and undesirable events. An integral restriction to investigations included having less dietary evaluation and dietary biochemistry, as the analysis geriatrician.