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Romera-Liebana L, Orfila F, Segura JM, Real J, Fabra ML, Möller M, Lancho S, Ramirez A, Marti N, Cullell M, Bastida N, Martinez D, Giné M, Cendrós P, Bistuer A, Perez E, Fabregat MA, Foz G. Effects of a Primary Care-Based Multifactorial Intervention on Physical and Cognitive Function in Frail, Elderly Individuals: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2019; 73:1688-1674. [PMID: 29346524 PMCID: PMC6248206 DOI: 10.1093/gerona/glx259] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 01/10/2023] Open
Abstract
Background Detecting and managing frailty at early stages can prevent disability and other adverse outcomes. The study aim was to evaluate whether a multifactorial intervention program could modify physical and cognitive frailty parameters in elderly individuals. Methods We conducted a multicenter, randomized, single-blind, parallel-group trial in community-living prefrail/frail elderly individuals in Barcelona. A total of 352 patients, aged ≥65 years old with positive frailty screening, was randomized into two groups to receive a 12-week multidisciplinary intervention or usual care, with concealed allocation. The intervention consisted of: exercise training, intake of hyperproteic nutritional shakes, memory training, and medication review. Main outcome assessments with multivariate analysis were conducted at 3 and 18 months. Results A total of 347 participants (98.6%) completed the study, mean age 77.3 years, 89 prefrail subjects (25.3%), and 75.3% female (n = 265). Eighteen-month assessments were performed in 76% of the sample. After 3 and 18 months, adjusted means difference between-groups showed significant improvements for the intervention group in all comparisons: Short Physical Performance Battery score improved 1.58 and 1.36 points (p < .001), handgrip strength 2.84 and 2.49 kg (p < .001), functional reach 4.3 and 4.52 cm (p < .001), and number of prescriptions decreased 1.39 and 1.09 (p < .001), respectively. Neurocognitive battery also showed significant improvements across all dimensions at 3 and 18 months. Conclusions A physical, nutritional, neurocognitive, and pharmacological multifaceted intervention was effective in reversing frailty measures both at short-term and 18 months. Lasting benefits of a multi-intervention program among frail elderly individuals encourage its prioritization.
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Affiliation(s)
- Laura Romera-Liebana
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain.,Universitat Autonoma de Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Francesc Orfila
- Institut Universitari d'Investigació en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institut Catala De La Salut, Gerencia Barcelona Ciutat, Spain
| | - Josep Maria Segura
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigacio en Atenció Primaria Jordi Gol (IDIAP Jordi Gol), Spain.,Epidemiologia i Salut Pública, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERDEM, Badalona, Spain
| | - Maria Lluïsa Fabra
- Rehabilitation Unit, Drassanes Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Mercedes Möller
- Rehabilitation Unit, Drassanes Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Santiago Lancho
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Anna Ramirez
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Nuria Marti
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Montserrat Cullell
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Nuria Bastida
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Dolors Martinez
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Maria Giné
- Blanquerna Universitat Ramon Llull Facultat de Psicologia Ciencies de l'Educacio i de l'Esport, Barcelona, Spain
| | | | - Anna Bistuer
- Rehabilitation Unit, Drassanes Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Elena Perez
- Institut Català d'Assistencia i Serveis Socials (ICASS), Barcelona, Spain
| | | | - Gonçal Foz
- Primary healthcare centre Raval Nord, Institut Català de la Salut, Barcelona, Spain
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Negm AM, Kennedy CC, Thabane L, Veroniki AA, Adachi JD, Richardson J, Cameron ID, Giangregorio A, Papaioannou A. Management of frailty: a protocol of a network meta-analysis of randomized controlled trials. Syst Rev 2017; 6:130. [PMID: 28679416 PMCID: PMC5499023 DOI: 10.1186/s13643-017-0522-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/16/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Frailty is a common syndrome affecting 5-17% of community-dwelling older adults. Various interventions are used to prevent or treat frailty. Given the diversity of singular and multi-faceted frailty interventions, not all of them have been compared in head-to-head studies. Network meta-analyses provide an approach to simultaneous consideration of the relative effectiveness of multiple treatment alternatives. This systematic review and network meta-analysis of RCTs aims to determine the comparative effect of interventions targeting the prevention or treatment of frailty. METHOD We will identify relevant RCTs, in any language and publication date, by a systematic search of databases including MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Central Registry of Controlled Trials (CENTRAL), HealthSTAR, DARE, PsychINFO, PEDro, SCOPUS, and Scielo. Duplicate title and abstract and full-text screening will be performed. Authors will extract data and assess risk of bias (using the Cochrane Risk of Bias tool) of eligible studies. The review interventions will include (1) physical activity only, (2) physical activity with protein supplementation or other nutritional supplementation, (3) psychosocial intervention, (4) medication management, (5) pharmacotherapy, and (6) multi-faceted intervention (defined as an intervention that combine physical activity and/or nutrition with any of the following: (1) psychosocial intervention, (2) medication management, and (3) pharmacotherapy). Our primary outcome is difference in change of physical frailty from baseline measured by a reliable and valid frailty measure. Secondary outcomes and the assessments are (1) cognition, (2) short physical performance battery, (3) any other physical performance measure, (4) treatment cost, (5) quality of life, and (6) any adverse outcome. We will conduct a network meta-analysis using a Bayesian hierarchical model. We will also estimate the ranking probabilities for all treatments at each possible rank for each intervention and will assess the certainty of the estimates of effect using GRADE approach. DISCUSSION To the best of our knowledge, this will be the first systematic review and network meta-analysis considering the direct and indirect effect of interventions targeting frailty prevention or treatment. Given the established high prevalence and socio-economic burden of frailty, there is an urgent need for a high-quality systematic review to inform evidence-based management of frailty. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2016 CRD42016037465 .
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Affiliation(s)
- Ahmed M Negm
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, St Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada. .,School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7A, Canada.
| | - Courtney C Kennedy
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, St Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - Areti-Angeliki Veroniki
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7A, Canada
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Aidan Giangregorio
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, St Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada
| | - Alexandra Papaioannou
- Geriatric Education and Research in Aging Sciences (GERAS) Centre, St Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.,Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
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Trivedi D, Goodman C, Gage H, Baron N, Scheibl F, Iliffe S, Manthorpe J, Bunn F, Drennan V. The effectiveness of inter-professional working for older people living in the community: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:113-28. [PMID: 22891915 DOI: 10.1111/j.1365-2524.2012.01067.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Health and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (interventions delivering acute, chronic, palliative and preventive care) identified within each model of IPW. We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models: Overall, there is weak evidence of effectiveness and cost-effectiveness for IPW, although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing/care home use. Study quality varied considerably and high quality evaluations as well as observational studies are needed to identify the key components of effective IPW in relation to user-defined outcomes. Differences in local contexts raise questions about the applicability of the findings and their implications for practice. We need more information on the outcomes of the process of IPW and evaluations of the effectiveness of different configurations of health and social care professionals for the care of community dwelling older people.
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Affiliation(s)
- Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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Ollonqvist K, Palkeinen H, Aaltonen T, Pohjolainen T, Puukka P, Hinkka K, Pöntinen S. Alleviating Loneliness among Frail Older People – Findings from a Randomised Controlled Trial. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2008.9721760] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Slivinske LR, Slivinske JD, Causey LA, Wyant KA. Evaluating the Effectiveness of the Trumbull Advocacy and Protective Network: A Formative Evaluation. J Appl Gerontol 2010. [DOI: 10.1177/0733464810361347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Trumbull Advocacy and Protective Network (TAPN) in Ohio is a county network of agencies in social services, government, medicine, law enforcement, and housing that coordinates and integrates services and programs for seniors with extraordinary needs. The purpose of this study was to assess the strengths and weaknesses of TAPN and make recommendations for improving its effectiveness. Seventeen TAPN member agencies participated in this formative evaluation in Phase 1, whereas 19 participated in Phase 2. The fact that mean scale scores for the TAPN Accomplishment Scale increased significantly over time was revealed by t tests. The most important changes were in addressing the special needs of older adults being served by more than one agency, advocating for the efficient and effective allocation of resources, enabling agencies to better serve their clients, and offering a “single focus location” for advocacy. Important future activities and functions of TAPN were identified, and the lessons learned were described.
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Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, Monaghan N, Cameron ID. Frailty Intervention Trial (FIT). BMC Geriatr 2008; 8:27. [PMID: 18851754 PMCID: PMC2579913 DOI: 10.1186/1471-2318-8-27] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 10/13/2008] [Indexed: 11/25/2022] Open
Abstract
Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems, has lost functional abilities and is likely to deteriorate further. However, despite its common use, only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence. The criteria Fried and colleagues used to define the frailty syndrome will be used in this study (i.e. weight loss, fatigue, decreased grip strength, slow gait speed, and low physical activity). Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment, and single interventions such as exercise programs or nutritional supplementation, but no interventions have been developed to specifically reverse the syndrome of frailty. We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty, mobility, hospitalisation and institutionalisation in frail older people. Methods and Design A single centre randomised controlled trial comparing a multidisciplinary intervention with usual care. The intervention will target identified characteristics of frailty, functional limitations, nutritional status, falls risk, psychological issues and management of chronic health conditions. Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital. Participants will be followed for a 12-month period. Discussion This research is an important step in the examination of specifically targeted frailty interventions. This project will assess whether an intervention specifically targeting frailty can be implemented, and whether it is effective when compared to usual care. If successful, the study will establish a new approach to the treatment of older people at risk of further functional decline and institutionalisation. The strategies to be examined are readily transferable to routine clinical practice and are applicable broadly in the setting of aged care health services. Trial Registration Australian New Zealand Clinical Trails Registry: ACTRN12608000250336.
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Affiliation(s)
- Nicola Fairhall
- Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Sydney Australia.
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Ollonqvist K, Aaltonen T, Karppi SL, Hinkka K, Pöntinen S. Network-based rehabilitation increases formal support of frail elderly home-dwelling persons in Finland: randomised controlled trial. HEALTH & SOCIAL CARE IN THE COMMUNITY 2008; 16:115-125. [PMID: 18290977 DOI: 10.1111/j.1365-2524.2007.00733.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The AGE study is a national randomised, long-term, multicentre research project aimed at comparing a new network-based rehabilitation programme with the use of standard health and social services. The use of home help services is associated with increasing age, living alone and having difficulties with activities of daily living. During a rehabilitation intervention the elderly participants' need for care can be assessed. The focus of this paper is to investigate the possible effects of the network-based rehabilitation programme on the use of informal and formal support among home-dwelling elderly at a high risk of long-term institutionalisation. The randomised controlled trial with a 12-month follow-up was implemented in 7 rehabilitation centres and 41 municipalities in Finland. The participants were recruited between January and October 2002. A total of 708 home-dwelling persons aged 65 years or older with progressively decreasing functional capacity and at the risk of being institutionalised within 2 years participated. Persons with acute or progressive diseases or poor cognitive capacity (Mini Mental State Examination<18 points), and those who had participated in any inpatient rehabilitation during the preceding 5 years, were excluded. Participants were randomly allocated to the intervention group (n=343) or to the control group (n=365). The intervention consisted of a network-based rehabilitation programme specifically designed for frail elderly people. Main outcome measures included the help received from relatives and municipal or private services. The use of municipal services increased more in the intervention group (P<0.05) than in the control group. Support from relatives decreased in the control group. The rehabilitees' ability to manage with daily activities decreased and they received additional help; hence, in this respect the rehabilitation model seems successful. A longer follow-up within the still ongoing AGE study is needed to verify whether the programme actually can delay long-term care.
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Wallin M, Talvitie U, Cattan M, Karppi SL. Construction of group exercise sessions in geriatric inpatient rehabilitation. HEALTH COMMUNICATION 2008; 23:245-252. [PMID: 18569053 DOI: 10.1080/10410230802055349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
There is little knowledge about the ways geriatric physiotherapy is being carried out in practice and about the situational construction of formal policies for promoting physical activity. This article examines how professional physiotherapists and frail community-dwelling older adults as their clients use talk and action to construct a group exercise session in an inpatient rehabilitation setting in Finland. The analysis of 7 group exercise sessions with a total of 52 clients and 9 professional physiotherapists revealed 3 different practitioner approaches, which served different functions in older adults' empowerment and lifestyle activity change. The highly structured approach favored taciturn physical performances completed independently and successfully by frail older adults. The guided exercise approach with individualized guidance encouraged occasional coconstruction of shared understanding of learning the exercises. The circuit training approach facilitated occasional self-regulation by the clients. The results of this study indicate that a combination of different approaches is required to address the multifaceted needs of heterogeneous frail older adults.
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Affiliation(s)
- Marjo Wallin
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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