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Dzando G, Ward P, Gesesew HA, Tyndall J, Ambagtsheer RC. Prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries: A mixed method systematic review. Arch Gerontol Geriatr 2024; 121:105360. [PMID: 38341959 DOI: 10.1016/j.archger.2024.105360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Frailty is increasingly becoming a public health concern, especially among vulnerable populations. Older migrants from Low- and Middle-Income Countries to High Income Countries present with poorer health and are at increased risk of becoming frail. This review aims to explore the prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries. METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five electronic databases were comprehensively searched for relevant literature published from January 1, 2000, to April 30, 2023. Quality appraisal for the quantitative studies was done with the Joanna Brigg's critical appraisal tool for analytic cross-sectional studies, and the qualitative studies were assessed with the Critical Appraisal Skill Program tool for qualitative studies. RESULT Seven studies met the inclusion criteria. Frailty was assessed using modified versions of the Frailty Phenotype and Frailty Index. The prevalence of frailty using the Frailty Phenotype was 16.6 %, and 17 % to 61.9 % according to the Frailty Index. The perceptions and experiences of frailty were characterised by chronic ill-health and a review of healthy pre-migration and early migration lives. CONCLUSION Despite the variation in frailty assessment methods, the high prevalence of frailty among older migrants was highlighted across the included studies. The perceptions and experiences of frailty reflect a state of resignation which can complicate the state of frailty. There is the need for ongoing research among migrant groups to identify their predisposition to frailty for early intervention.
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Affiliation(s)
- Gideon Dzando
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Paul Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia; College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Jessica Tyndall
- Library, Torrens University Australia, Adelaide, SA, Australia
| | - Rachel C Ambagtsheer
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, Australia
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Saleem A, Appannah A, Meyer C, Hutchinson AM, Mills A, Smit DV, Boyd L, Rose M, Sutherland F, O'Keefe F, Lowthian JA. A qualitative exploration of challenges recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty: lessons learnt amidst the COVID-19 pandemic in Melbourne, Australia. BMJ Open 2024; 14:e082618. [PMID: 38803255 DOI: 10.1136/bmjopen-2023-082618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES Researchers face numerous challenges when recruiting participants for health and social care research. This study reports on the challenges faced recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty, and highlights lessons learnt amidst the COVID-19 pandemic. DESIGN A qualitative study design was used. Referrer interviews were conducted to explore the recruitment challenges faced by the frontline workers. An audit of the research participant (aged ≥65) database was also undertaken to evaluate the reasons for refusal to participate and withdrawal from the study. SETTING Hospital emergency departments (EDs) and a home care provider in Melbourne, Australia. PARTICIPANTS Frontline workers and older adults. RESULTS From May 2022 to June 2023, 71 referrals were received. Of those referrals, only 13 (18.3%) agreed to participate. Three participants withdrew immediately after baseline data collection, and the remaining 10 continued to participate in the programme. Reasons for older adult non-participation were (1) health issues (25.3%), (2) ineligibility (18.3%), (3) lack of interest (15.5%), (4) perceptions of being 'too old' (11.2%) and (5) perceptions of being too busy (5.6%). Of those participating, five were female and five were male. Eleven referrer interviews were conducted to explore challenges with recruitment, and three themes were generated after thematic analysis: (1) challenges arising from the COVID-19 pandemic, (2) characteristics of the programme and (3) health of older adults. CONCLUSION Despite using multiple strategies, recruitment was much lower than anticipated. The ED staff were at capacity associated with pandemic-related activities. While EDs are important sources of participants for research, they were not suitable recruitment sites at the time of this study, due to COVID-19-related challenges. Programme screening characteristics and researchers' inability to develop rapport with potential participants also contributed to low recruitment numbers. TRIAL REGISTRATION NUMBER ACTRN12620000533998; Pre-results.
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Affiliation(s)
- Ahsan Saleem
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
| | - Arti Appannah
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Amber Mills
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Leanne Boyd
- Eastern Health, Melbourne, Victoria, Australia
| | | | - Fran Sutherland
- Cabrini Health Consumer Representative, Melbourne, Victoria, Australia
| | | | - Judy A Lowthian
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Wang X, Liu Z. Navigating Aged Care Services with GIS: Trends, Developments, and Future Directions. BMC Geriatr 2024; 24:243. [PMID: 38468239 PMCID: PMC10926560 DOI: 10.1186/s12877-024-04799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND With the growing challenge of an aging population, emerging technologies are increasingly being integrated into the production, organization, and delivery of aged care services. Geographic Information System (GIS), a computer-based tool for spatial information analysis and processing, has made significant strides in the allocation of care recources and service delivery for older adults, a notably vulnerable group. Despite its growing importance, cross-disciplinary literature reviews on this theme are scare. This scoping review was conducted to encapsulate the advancements and discern the future trajectory of GIS applications in aged care services. METHODS A comprehensive search across nine databases yielded 5941 articles. Adhering to specific inclusion and exclusion criteria, 61 articles were selected for a detailed analysis. RESULTS The 61 articles span from 2003 to 2022, with a notable increase in publications since 2018, comprising 41 articles (67% of the total) published between 2018-2022. Developed countries contributed 66% of the papers, with 45% focusing on accessibility issues. In the domain of aged care services, GIS has been predominantly utilized for model construction, mapping, and site selection, with a growing emphasis on addressing the unique needs of different subgroups of older adults. CONCLUSION The past two decades have seen substantial growth in the application of GIS in aged care services, reflecting its increasing importance in this field. This scoping review not only charts the historical development of GIS applications in aged care services but also underscores the need for innovative research approaches. Future directions should emphasize the integration of GIS with diverse methodologies to address the heterogeneous needs of older adults and improve the overall delivery of aged care services. Such advancements in GIS applications have the potential to significantly enhance the efficiency, accessibility, and quality of care for the aging population.
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Affiliation(s)
- Xuehan Wang
- School of Public Administration, Central South University, Changsha, Hunan, 410004, China
| | - Zhihan Liu
- School of Public Administration, Central South University, Changsha, Hunan, 410004, China.
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Zheng LX, Walsh EI, Sutarsa IN. Provision of health services for elderly populations in rural and remote areas in Australia: A systematic scoping review. Aust J Rural Health 2023; 31:805-825. [PMID: 37469118 DOI: 10.1111/ajr.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/18/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia. OBJECTIVE The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature. DESIGN A systematic scoping review of peer-reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science). FINDINGS Thirty-two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences. DISCUSSION Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient-centred care for elderly populations in rural and remote areas. CONCLUSION The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents.
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Affiliation(s)
- Ling Xiao Zheng
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Erin I Walsh
- Population Health Exchange (PHXchange), National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - I Nyoman Sutarsa
- Rural Clinical School, School of Medicine and Psychology, The Australian National University, Acton, Australian Capital Territory, Australia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Pincombe A, Afzali HHA, Visvanathan R, Karnon J. Development and validation of an individual-based state-transition model for the prediction of frailty and frailty-related events. PLoS One 2023; 18:e0290567. [PMID: 37616298 PMCID: PMC10449188 DOI: 10.1371/journal.pone.0290567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Frailty is a biological syndrome that is associated with increased risks of morbidity and mortality. To assess the value of interventions to prevent or manage frailty, all important impacts on costs and outcomes should be estimated. The aim of this study is to describe the development and validation of an individual-based state transition model that predicts the incidence and progression of frailty and frailty-related events over the remaining lifetime of older Australians. An individual-based state transition simulation model comprising integrated sub models that represent the occurrence of seven events (mortality, hip fracture, falls, admission to hospital, delirium, physical disability, and transitioning to residential care) was developed. The initial parameterisation used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The model was then calibrated for an Australian population using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The simulation model established internal validity with respect to predicting outcomes at 24 months for the SHARE population. Calibration was required to predict longer terms outcomes at 48 months in the SHARE and HILDA data. Using probabilistic calibration methods, over 1,000 sampled sets of input parameter met the convergence criteria across six external calibration targets. The developed model provides a tool for predicting frailty and frailty-related events in a representative community dwelling Australian population aged over 65 years and provides the basis for economic evaluation of frailty-focussed interventions. Calibration to outcomes observed over an extended time horizon would improve model validity.
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Affiliation(s)
- Aubyn Pincombe
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - Renuka Visvanathan
- Aged & Extended Care Services (Geriatric Medicine), Acute and Urgent Care, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Woodville South, SA, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Visvanathan R, Campbell D. Re-imagining health care for an ageing population. Med J Aust 2023; 219:105-106. [PMID: 37414739 DOI: 10.5694/mja2.52023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Renuka Visvanathan
- The Queen Elizabeth Hospital, Adelaide, SA
- Basil Hetzel Institute for Translational Health Research, Queen Elizabeth Hospital, Adelaide, SA
- Adelaide Medical School, the University of Adelaide, Adelaide, SA
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Sajeev S, Champion S, Maeder A, Gordon S. Machine learning models for identifying pre-frailty in community dwelling older adults. BMC Geriatr 2022; 22:794. [PMID: 36221059 PMCID: PMC9554971 DOI: 10.1186/s12877-022-03475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/15/2022] [Indexed: 04/11/2023] Open
Abstract
Background There is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty. Methods A cohort of 656 independent community dwelling adults, aged 40–75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy. Results Two stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS. Conclusions The results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03475-9.
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Affiliation(s)
- Shelda Sajeev
- School of Business and Information Systems, Torrens University, 88 Wakefield St, Adelaide, SA, 5000, Australia. .,Centre for Artificial Intelligence Research and Optimisation, Torrens University, Adelaide, Australia. .,Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
| | - Anthony Maeder
- Flinders Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
| | - Susan Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, South, 5042, Australia
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Milte R, Petersen J, Boylan J, Henwood T, Hunter S, Lange B, Lawless M, Torode S, Lewis LK. Prevalence and determinants of physical frailty among people living in residential aged care facilities: a large-scale retrospective audit. BMC Geriatr 2022; 22:424. [PMID: 35568811 PMCID: PMC9107174 DOI: 10.1186/s12877-022-03101-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Physical frailty is associated with increased risk of falls, hospitalisation and mortality. There is a dearth of information on physical frailty of older adults living in residential aged care. This study aimed to describe physical frailty in aged care residents and investigate possible determinants of frailty. Method A retrospective audit of resident records was undertaken across 14 residential aged care facilities. Data were extracted on all consenting residents who had completed measures relating to frailty (Short Physical Performance Battery SPPB; grip strength). All data of the first record of measures were extracted, resident characteristics, and the time from admission to assessment. Summary statistics were completed. Differences between sub-groups were explored (Mann-Whitney U, Kruskall-Wallis Ranked tests). Associations between variables were explored with Chi-squared and Pearson correlations. Determinants of physical frailty were determined with linear regression analyses. Alpha (2-sided) was 0.05. Results Data were extracted for 1241 residents (67% female), with a mean age of 86.0 (7.6) years. Males had a significantly lower time from admission to assessment of frailty (p ≤ 0.001). The average SPPB score was 4.1 (3.3), 75% of residents were frail and 19% pre-frail. Bivariate analyses indicated no significant relationships between grip strength and SPPB score, but significant differences for grip strength, where males were significantly stronger (males 20.2 ± 8.3 kg; females 12.4 ± 5.4 kg; p ≤ 0.001). There was a significant positive relationship between SPPB total score and grip strength, gender (p ≤ 0.001), and marital status (p = 0.049) and a negative relationship between time from admission to assessment and SPPB total score (p ≤ 0.001). There were significant negative relationships between gender (p ≤ 0.001) and age (p ≤ 0.001), and time from admission to assessment (p ≤ 0.001) with grip strength. Conclusion Older adults living in residential aged care have a high level of physical frailty which may lead to increased risk of adverse outcomes. Time in the residential aged care setting and age appear to predict physical frailty. There is a need for a consistent battery of measures to continually monitor frailty and programs to address the high levels of frailty in residential aged care.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Stacey Torode
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
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Taylor D, Amare AT, Edwards S, Inacio M, Visvanathan R. A vulnerable residential environment is associated with higher risk of mortality and early transition to permanent residential aged care for community dwelling older South Australians. Age Ageing 2022; 51:6540139. [PMID: 35231094 PMCID: PMC8887847 DOI: 10.1093/ageing/afac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives This study examined the impact of the residential environment, measured by the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, on risk of mortality or entry into Permanent Residential Aged Care (PRAC). Design A retrospective cohort study using data from the Registry of Senior Australians (ROSA) was conducted. HAVEN Index values were matched to the ROSA by residential postcode. Study setting and Participants Older individuals living in metropolitan Adelaide and receiving their first eligibility assessment for aged care services between 2014 and 2016 (N = 16,944). Main Outcome Measure Time to death and entry into PRAC were the main outcomes. Results A higher HAVEN Index value, which represents a favourable residential environment, was associated with a lower risk of mortality and delayed entry to PRAC. For every 0.1 unit increase in HAVEN Index value, the risk of mortality is 3% lower (adjusted hazard ratio [HR], 95% confidence interval [CI] = 0.97, 0.96–0.99) and the risk of entry to PRAC is 5% lower (adjusted subdistribution HR, 95%CI = 0.95, 0.94–0.97) in the first 2 years following aged care assessment. After 2 years, the HAVEN Index was not associated with the risk of transition to PRAC. Conclusion Place-based health inequalities were identified in Australians seeking aged care services, demonstrating that a better understanding of local neighbourhoods may provide insight into addressing ageing inequalities. Spatial indexes, such as the HAVEN Index, are useful tools to identify areas where populations are more vulnerable to adverse health outcomes, informing responses to prioritise local improvements and health interventions to enable healthy ageing.
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Affiliation(s)
- Danielle Taylor
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville, SA, Australia
- Basil Hetzel Institute of Translational Health Research, The Queen Elizabeth Hospital Woodville South, SA, Australia
- Corresponding Author: Dr Danielle Taylor, National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Basil Hetzel Institute of Translational Health Research, The Queen Elizabeth Hospital DX 465701, 28 Woodville Rd, Woodville South, SA, Australia, 5011.
| | - Azmeraw T Amare
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville, SA, Australia
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville, SA, Australia
- Basil Hetzel Institute of Translational Health Research, The Queen Elizabeth Hospital Woodville South, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
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Fhon JRS, Cabral LMS, Giacomini SBL, Dos Reis NA, Resende MC, Rodrigues RAP. Frailty and sociodemographic and health factors, and social support network in the brazilian elderly: A longitudinal study. Rev Esc Enferm USP 2021; 56:e20210192. [PMID: 34908099 PMCID: PMC10132735 DOI: 10.1590/1980-220x-reeusp-2021-0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify and analyze the sociodemographic and health factors and the social support network of the elderly associated with frailty in the assessments carried out between 2007/2008 and 2018. METHODS This is a longitudinal study with elderly people aged ≥65 years living in the community. The instruments used were those for Demographic Profile, the Mini Mental State Examination, the Functional Independence Measure, Lawton and Brody Scale, Geriatric Depression Scale, Minimum Relationship Map for the Elderly, and Edmonton Frail Scale. Descriptive analysis and linear regression were used, all tests with p < 0.05. RESULTS Of the 189 elderly in the study period (2007/2008-2018), most were 80 years old and over, with an average of 82.31 years old; they were women, with no partner, who lived with other family members and were retired. In the final analysis, regardless of age and sex, a decrease in functional independence, an increase in depressive symptoms, an increase in the number of self-reported illnesses, and an increase in the frailty score were observed. CONCLUSION The factors that were associated with the increase in frailty of the elderly during the study period were age, female sex, and no partner. The health team, which includes nurses, shall be aware of changes and develop care plans to prevent or avoid their progression.
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Affiliation(s)
- Jack Roberto Silva Fhon
- Universidade de São Paulo, Escola de Enfermagem, Departamento Médico-Cirúrgico, São Paulo, SP, Brazil
| | - Luípa Michele Silva Cabral
- Universidade Federal de Goiás, Unidade Acadêmica de Biotecnologia, Departamento de Enfermagem, Catalão, GO, Brazil
| | - Suellen Borelli Lima Giacomini
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Enfermagem Geral e Especializada, Ribeirão Preto, SP, Brazil
| | - Nayara Araújo Dos Reis
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Enfermagem Geral e Especializada, Ribeirão Preto, SP, Brazil
| | - Marcela Cristina Resende
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento Enfermagem Geral e Especializada, Ribeirão Preto, SP, Brazil
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Lewis LK, Henwood T, Boylan J, Hunter S, Lange B, Lawless M, Milte R, Petersen J. Re-thinking reablement strategies for older adults in residential aged care: a scoping review. BMC Geriatr 2021; 21:667. [PMID: 34847860 PMCID: PMC8638477 DOI: 10.1186/s12877-021-02627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
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Affiliation(s)
- Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Sinclair DR, Maharani A, Stow D, Welsh CE, Matthews FE. Can vaccination roll-out be more equitable if population risk is taken into account? PLoS One 2021; 16:e0259990. [PMID: 34780553 PMCID: PMC8592495 DOI: 10.1371/journal.pone.0259990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background COVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients. Methods We compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID-19: atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status. Results We estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England. Conclusions Vaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system.
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Affiliation(s)
- David R. Sinclair
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Asri Maharani
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Daniel Stow
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Claire E. Welsh
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Fiona E. Matthews
- Population Health Sciences Institute, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
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Roberts S, Collins P, Rattray M. Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review. Nutrients 2021; 13:nu13072316. [PMID: 34371823 PMCID: PMC8308465 DOI: 10.3390/nu13072316] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast 4219, Australia
- Correspondence: ; Tel.: +61-7-5552-9557
| | - Peter Collins
- Dietetics and Food Services, Mater Health, Brisbane 4101, Australia;
- Mater Research Institute, University of Queensland, Brisbane 4101, Australia
| | - Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
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Visvanathan R, Amare AT, Wesselingh S, Inacio MC. General practitioner conduct of clinical services representing comprehensive geriatric assessment is associated with lower risk of mortality in older Australians receiving home care packages. Age Ageing 2021; 50:1243-1251. [PMID: 33352580 DOI: 10.1093/ageing/afaa272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The purpose of this paper is to investigate the utilisation of general practice Medicare Benefit Schedule (MBS) services aligned to Comprehensive Geriatric Assessment (CGA) within 6 months of an aged care eligibility assessment and its effects on mortality and transition to permanent residential aged care (PRAC). DESIGN Retrospective cohort study from the Historical Cohort of the Registry of Senior Australians. SETTING Community. PARTICIPANTS In total, 69,171 Individuals (aged 75+) receiving home care packages (HCPs) between 2011 and 2015. OUTCOME MEASURES Mortality and transition to PRAC. RESULTS The claims for a management plan with team care arrangement (TCA) within 3 months of the health assessment (i.e. CGA) was present in 5% and associated with 14% lower mortality (adjusted hazard ratio [aHR], 95%CI = 0.86, 0.80-0.93) compared to no claims, lower than that seen with partial CGA which was either health assessment claims only 7.0% (aHR, 95%CI = 0.93, 0.89-0.97) or management plan coupled with TCA claims only 9.0% (aHR, 95%CI = 0.91, 0.89-0.97). This pattern was seen in those frailer but not in those where the frailty index score was <0.21. Claims for management plans coupled with TCAs alone were associated with a 10% lower transition to PRAC (asHR, 95%CI = 0.90, 0.85-0.96) in those with FI score < 0.21 while this estimate was not significant in individuals with FI score ≥ 0.21. CONCLUSION It appears the conduct of a combination of interventions considered to be components of the CGA by GPs was associated with a lower risk of mortality that no claims or partial conduct of CGA.
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Affiliation(s)
- Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre and the National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5011, Australia
| | - Azmeraw T Amare
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre and the National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5011, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI) Adelaide 5001, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI) Adelaide 5001, Australia
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Jadczak AD, Robson L, Cooper T, Bell JS, Visvanathan R. The Frailty In Residential Sector over Time (FIRST) study: methods and baseline cohort description. BMC Geriatr 2021; 21:99. [PMID: 33535968 PMCID: PMC7857100 DOI: 10.1186/s12877-020-01974-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Frailty In Residential Sector over Time (FIRST) Study is a 3-year prospective cohort study investigating the health of residents living in residential aged care services (RACS) in South Australia. The study aims to examine the change in frailty status and associated health outcomes. METHODS This interim report presents data from March 2019-October 2020. The study setting is 12 RACS from one organisation across metropolitan and rural South Australia involving 1243 residents. All permanent (i.e. respite or transition care program excluded) residents living in the RACS for at least 8 weeks were invited to participate. Residents who were deemed to be medically unstable (e.g. experiencing delirium), have less than 3 months to live, or not fluent in English were excluded. Data collected included frailty status, medical diagnoses, medicines, pain, nutrition, sarcopenia, falls, dementia, anxiety and depression, sleep quality, quality of life, satisfaction with care, activities of daily living, and life space use at baseline and 12-months. Data Linkage will occur over the 3 years from baseline. RESULTS A total of 561 permanent residents (mean age 87.69 ± 7.25) were included. The majority of residents were female (n = 411, 73.3%) with 95.3% (n = 527) being classified as either frail (n = 377, 68.2%) or most-frail (n = 150, 27.1%) according to the Frailty Index (FI). Most residents were severely impaired in their basic activities of daily living (n = 554, 98.8%), and were at-risk of malnutrition (n = 305, 55.0%) and at-risk of sarcopenia (n = 492, 89.5%). Most residents did not experience pain (n = 475, 85.4%), had normal daytime sleepiness (n = 385, 69.7%), and low anxiety and depression scores (n = 327, 58.9%). CONCLUSION This study provides valuable information on the health and frailty levels of residents living in RACS in South Australia. The results will assist in developing interventions that can help to improve the health and wellbeing of residents in aged care services. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12619000500156 ).
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Affiliation(s)
- Agathe Daria Jadczak
- National Health and Medical Research Council Centre of Research Excellence Frailty and Healthy Aging, Adelaide, South Australia, Australia.
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
- Aged and Extended Care Services, Basil Hetzel Institute for Translational Health Research and The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
| | - Leonie Robson
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - Tina Cooper
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence Frailty and Healthy Aging, Adelaide, South Australia, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, Basil Hetzel Institute for Translational Health Research and The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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Clinical Implications of Research on Frailty. J Am Med Dir Assoc 2021; 22:524-526. [PMID: 33485857 DOI: 10.1016/j.jamda.2021.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
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Jadczak AD, Visvanathan R, Barnard R, Luscombe-Marsh N. A Randomized Controlled Pilot Exercise and Protein Effectiveness Supplementation Study (EXPRESS) on Reducing Frailty Risk in Community-Dwelling Older People. J Nutr Gerontol Geriatr 2021; 40:26-45. [PMID: 33691612 DOI: 10.1080/21551197.2021.1886222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This pilot study aimed to examine the feasibility and effectiveness of a 6-months multi-component exercise program combined with twice daily consumption of either rice (RicePro) or whey-based (WheyPro) protein supplements (2 × 20 g of protein) on gait speed, grip strength and physical performance in community-dwelling pre-frail and frail older adults. Secondary outcomes included: frailty score, muscle mass, quality of life, nutritional intake, cognitive performance, depression and physical activity levels. A total of 70 participants (mean age 73.34 ± 6.85 years) were randomly allocated to either RicePro (n = 36) or WheyPro (n = 34). No adverse events were reported in regards to the exercise, however, several gastrointestinal symptoms were noted with the whey protein causing two-fold more symptoms compared to the rice protein. No differences were found between the groups (p > 0.05), except the total consumed energy (kJ) (p = 0.014) and fat (g) (p = 0.012) which was significantly lower in WheyPro. The results indicate that the quality of protein may not be as important as long as a sufficient amount is consumed.
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Affiliation(s)
- Agathe Daria Jadczak
- National Health and Medical Research Council Centre of Research Excellence Frailty and Healthy Ageing, University of Adelaide, Adelaide, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence Frailty and Healthy Ageing, University of Adelaide, Adelaide, Australia
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Robert Barnard
- Centre for Physical Activity in Ageing (CPAA), Central Adelaide Local Health Network, Adelaide, Australia
| | - Natalie Luscombe-Marsh
- Health and Biosecurity, Commonwealth Scientific Industrial Research Organisation (CSIRO), Adelaide, Australia
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Arakawa Martins B, Jadczak AD, Dollard J, Barrie H, Mahajan N, Tam KL, Visvanathan R. Fifth-year medical students' perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty before and after a geriatric medicine course. Australas J Ageing 2020; 39:e472-e477. [PMID: 32124560 DOI: 10.1111/ajag.12788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/17/2019] [Accepted: 02/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the changes in fifth-year medical students' perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty after a 4.5-week geriatric medicine course. METHODS Students' perceived importance and competence was assessed before and after the course using a 26-item Likert scale questionnaire with scores ranging from 1 to 6. RESULTS Students' perceptions of the importance of defining frailty (P = .01), explaining what frailty is (P = .03), advising on nutritional needs (P = .001) and exercise (P = .001) and prescribing an exercise program (P < .001) significantly improved after the course. Medical students' perceived competence in assessing, diagnosing and managing frailty was low to moderate precourse and increased significantly postcourse (2.3 [1.2] 4.9 [2.9], mean [IQR], P < .001) across all items. CONCLUSION An appropriate curriculum focusing on geriatric health conditions such as frailty can improve senior medical students' perceived importance and competence in assessing, diagnosing and managing frailty.
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Affiliation(s)
- Beatriz Arakawa Martins
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Helen Barrie
- National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.,School of Social Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Neha Mahajan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Khai Loon Tam
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
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Haji Ali Afzali H, Karnon J, Theou O, Beilby J, Cesari M, Visvanathan R. Structuring a conceptual model for cost-effectiveness analysis of frailty interventions. PLoS One 2019; 14:e0222049. [PMID: 31509563 PMCID: PMC6738928 DOI: 10.1371/journal.pone.0222049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/19/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Frailty is a major health issue which impacts the life of older people, posing a significant challenge to the health system. One of the key emerging areas is the development of frailty interventions to halt or reverse the progression of the condition. In many countries, economic evidence is required to inform public funding decisions for such interventions, and cost-effectiveness models are needed to estimate long-term costs and effects. Such models should capture current clinical understanding of frailty, its progression and its health consequences. The objective of this paper is to present a conceptual model of frailty that can be used to inform the development of a cost-effectiveness model to evaluate frailty interventions. METHODS After critical analysis of the clinical and economic literature, a Delphi study consisting of experts from the disciplines of clinical medicine and epidemiology was undertaken to inform the key components of the conceptual model. We also identified relevant databases that can be used to populate and validate the model. RESULTS A list of significant health states/events for which frailty is a strong independent risk factor was identified (e.g., hip fracture, hospital admission, delirium, death). We also identified a list of important patient attributes that may influence disease progression (e.g., age, gender, previous hospital admissions, depression). A number of large-scale relevant databases were also identified to populate and validate the cost-effectiveness model. Face validity of model structure was confirmed by experts. DISCUSSION AND CONCLUSIONS The proposed conceptual model is being used as a basis for developing a new cost-effectiveness model to estimate lifetime costs and outcomes associated with a range of frailty interventions. Using an appropriate model structure, which more accurately reflects the natural history of frailty, will improve model transparency and accuracy. This will ultimately lead to better informed public funding decisions around interventions to manage frailty.
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Affiliation(s)
- Hossein Haji Ali Afzali
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Justin Beilby
- Torrens University, Adelaide, South Australia, Australia
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Renuka Visvanathan
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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