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Kvalsvik F, Larsen BH, Eilertsen G, Falkenberg HK, Dalen I, Haaland S, Storm M. Health Needs Assessment in Home-Living Older Adults: Protocol for a Pre-Post Study. JMIR Res Protoc 2024; 13:e55192. [PMID: 38635319 PMCID: PMC11066750 DOI: 10.2196/55192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Conducting a health needs assessment for older adults is important, particularly for early detection and management of frailty. Such assessments can help to improve health outcomes, maintain overall well-being, and support older adults in retaining their independence as they age at home. OBJECTIVE In this study, a systematic approach to health needs assessment is adopted in order to reflect real-world practices in municipal health care and capture the nuances of frailty. The aim is to assess changes in frailty levels in home-living older adults over 5 months and to examine the observable functional changes from a prestudy baseline (t1) to a poststudy period (t2). Additionally, the study explores the feasibility of conducting the health needs assessment from the perspective of home-living older adults and their informal caregivers. METHODS Interprofessional teams of registered nurses, physiotherapists, and occupational therapists will conduct 2 health needs assessments covering physical, cognitive, psychological, social, and behavioral domains. The study includes 40 home-living older adults of 75 years of age or older, who have applied for municipal health and care services in Norway. A quantitative approach will be applied to assess changes in frailty levels in home-living older adults over 5 months. In addition, we will examine the observable functional changes from t1 to t2 and how these changes correlate to frailty levels. Following this, a qualitative approach will be used to examine the perspectives of participants and their informal caregivers regarding the health needs assessment and its feasibility. The final sample size for the qualitative phase will be determined based on the participant's willingness to be interviewed. The quantitative data consist of descriptive statistics, simple tests, and present plots and correlation coefficients. For the qualitative analysis, we will apply thematic analysis. RESULTS The initial baseline assessments were completed in July 2023, and the second health needs assessments are ongoing. We expect the results to be available for analysis in the spring of 2024. CONCLUSIONS This study has potential benefits for not only older adults and their informal caregivers but also health care professionals. Moreover, it can be used to inform future studies focused on health needs assessments of this specific demographic group. The study also provides meaningful insights for local policy makers, with potential future implications at the national level. TRIAL REGISTRATION ClinicalTrials.gov NCT05837728; https://clinicaltrials.gov/study/NCT05837728. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55192.
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Affiliation(s)
- Fifi Kvalsvik
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Bente Hamre Larsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Grethe Eilertsen
- Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Helle K Falkenberg
- Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Ingvild Dalen
- Section of Biostatistics, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Stine Haaland
- Department of Health and Welfare services, Stavanger kommune, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
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2
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Mensah E, Ali K, Banya W, Kirkham FA, Mengozzi M, Ghezzi P, Rajkumar C. FRailty and Arterial stiffness - the role of oXidative stress and Inflammation (FRAXI study). Biomark Insights 2022; 17:11772719221130719. [PMID: 36275839 PMCID: PMC9583202 DOI: 10.1177/11772719221130719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/16/2022] [Indexed: 11/08/2022] Open
Abstract
Objective There is an association between frailty and arterial stiffness. However, arterial stiffness does not uniformly correlate with the spectrum of frailty states. Both oxidative stress and inflammaging contribute to vascular ageing. There are no human studies exploring links between arterial stiffness, oxidative stress, inflammaging and frailty. Our objective is to investigate arterial stiffness and inflammaging as predictors of frailty states. Methods An observational longitudinal cohort study will be used to examine the association between arterial stiffness, oxidative stress and inflammation in 50 older adults (⩾70 years) with clinical frailty scores (CFS) ⩽6 over 6 months. All study measurements will be taken at baseline. Frailty assessment will include hand-grip strength, timed-up and go test, mini-mental state examination, geriatric depression scale and sarcopenia using body composition measurements with Tanita®. Arterial stiffness measurements will include carotid-femoral pulse wave velocity (cfPWV) and carotid-radial pulse wave velocity (crPWV) using Complior (Alam Medical, France). CAVI device will measure Cardio-ankle vascular index and ankle brachial index (ABI). Oxidative stress blood markers nitrotyrosine (NT) and 8-hydroxy-2'-deoxyguanosin (8-oxo-dG) and inflammation markers high-sensitive C-reactive protein (hs-CRP) and interlukin-6(IL-6) will be measured at baseline and 6 month along with lipid profile and glycated haemoglobin. Results data analysis plan Descriptive statistics for continuous data using means and standard deviations for normality distributed variables or medians and inter-quartile ranges for skewed variables will be used. Participants will be categorised into CFS 1-3, and CFS 4-6. Categorical data will use frequencies and comparison between groups. Change in frailty between the groups over 6 months will be compared using paired t-test. Simple linear regression will be done between frailty measures, arterial stiffness, inflammation and oxidative stress biomarkers. Significance will be at P < .05. Conclusion This study data will inform a larger, multi-centre study exploring further the interplay between frailty, biomarkers and arterial stiffness parameters.
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Affiliation(s)
- Ekow Mensah
- Brighton and Sussex Clinical Trials
Unit, University Hospitals Sussex NHS Trust, Brighton, UK,Ekow Mensah, Brighton and Sussex Clinical
Trials Unit, University Hospitals Sussex NHS Trust, Audrey Emerton Building,
Eastern Road, Brighton, BN2 5BE, UK.
| | - Khalid Ali
- Brighton and Sussex Clinical Trials
Unit, University Hospitals Sussex NHS Trust, Brighton, UK,Department of Medicine, Brighton and
Sussex Medical School, University of Sussex, Brighton, UK
| | - Winston Banya
- Research Office, Royal Brompton and
Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London,
UK
| | - Frances Ann Kirkham
- Brighton and Sussex Clinical Trials
Unit, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Manuela Mengozzi
- Department of Medicine, Brighton and
Sussex Medical School, University of Sussex, Brighton, UK
| | | | - Chakravarthi Rajkumar
- Brighton and Sussex Clinical Trials
Unit, University Hospitals Sussex NHS Trust, Brighton, UK,Department of Medicine, Brighton and
Sussex Medical School, University of Sussex, Brighton, UK
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3
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Alharbi K, Blakeman T, van Marwijk H, Reeves D, Tsang JY. Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review. BMJ Open 2022; 12:e054780. [PMID: 35649605 PMCID: PMC9161080 DOI: 10.1136/bmjopen-2021-054780] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/24/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Identifying and managing the needs of frail people in the community is an increasing priority for policy makers. We sought to identify factors that enable or constrain the implementation of interventions for frail older persons in primary care. DESIGN A rapid realist review. DATA SOURCES Cochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We considered all types of empirical studies describing interventions targeting frailty in primary care. ANALYSIS We followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication criteria for our synthesis to systematically analyse and synthesise the existing literature and to identify (intervention-context-mechanism-outcome) configurations. We used normalisation processes theory to illuminate mechanisms surrounding implementation. RESULTS Our primary research returned 1755 articles, narrowed down to 29 relevant frailty intervention studies conducted in primary care. Our review identified two families of interventions. They comprised: (1) interventions aimed at the comprehensive assessment and management of frailty needs; and (2) interventions targeting specific frailty needs. Key factors that facilitate or inhibit the translation of frailty interventions into practice related to the distribution of resources; patient engagement and professional skill sets to address identified need. CONCLUSION There remain challenges to achieving successful implementation of frailty interventions in primary care. There were a key learning points under each family. First, targeted allocation of resources to address specific needs allows a greater alignment of skill sets and reduces overassessment of frail individuals. Second, earlier patient involvement may also improve intervention implementation and adherence. PROSPERO REGISTRATION NUMBER The published protocol for the review is registered with PROSPERO (CRD42019161193).
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Affiliation(s)
- Khulud Alharbi
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Harm van Marwijk
- Division of Primary Care and Public Health, University of Brighton, Falmer, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - David Reeves
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jung Yin Tsang
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
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4
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Bonora BM, Palano MT, Testa G, Fadini GP, Sangalli E, Madotto F, Persico G, Casciaro F, Vono R, Colpani O, Scavello F, Cappellari R, Abete P, Orlando P, Carnelli F, Berardi AG, De Servi S, Raucci A, Giorgio M, Madeddu P, Spinetti G. Hematopoietic progenitor cell liabilities and alarmins S100A8/A9-related inflammaging associate with frailty and predict poor cardiovascular outcomes in older adults. Aging Cell 2022; 21:e13545. [PMID: 35166014 PMCID: PMC8920446 DOI: 10.1111/acel.13545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 12/18/2022] Open
Abstract
Frailty affects the physical, cognitive, and social domains exposing older adults to an increased risk of cardiovascular disease and death. The mechanisms linking frailty and cardiovascular outcomes are mostly unknown. Here, we studied the association of abundance (flow cytometry) and gene expression profile (RNAseq) of stem/progenitor cells (HSPCs) and molecular markers of inflammaging (ELISA) with the cardiorespiratory phenotype and prospective adverse events of individuals classified according to levels of frailty. Two cohorts of older adults were enrolled in the study. In a cohort of pre-frail 35 individuals (average age: 75 years), a physical frailty score above the median identified subjects with initial alterations in cardiorespiratory function. RNA sequencing revealed S100A8/A9 upregulation in HSPCs from the bone marrow (>10-fold) and peripheral blood (>200-fold) of individuals with greater physical frailty. Moreover higher frailty was associated with increased alarmins S100A8/A9 and inflammatory cytokines in peripheral blood. We then studied a cohort of 104 more frail individuals (average age: 81 years) with multidomain health deficits. Reduced levels of circulating HSPCs and increased S100A8/A9 concentrations were independently associated with the frailty index. Remarkably, low HSPCs and high S100A8/A9 simultaneously predicted major adverse cardiovascular events at 1-year follow-up after adjustment for age and frailty index. In conclusion, inflammaging characterized by alarmin and pro-inflammatory cytokines in pre-frail individuals is mirrored by the pauperization of HSPCs in frail older people with comorbidities. S100A8/A9 is upregulated within HSPCs, identifying a phenotype that associates with poor cardiovascular outcomes.
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Affiliation(s)
| | | | - Gianluca Testa
- Department of Medicine and Health Sciences “Vincenzo Tiberio” University of Molise Campobasso Italy
| | | | | | | | | | | | | | | | - Francesco Scavello
- Unit of Experimental Cardio‐Oncology and Cardiovascular Aging Centro Cardiologico Monzino‐IRCCS Milan Italy
| | | | - Pasquale Abete
- Department of Translational Medical Sciences University of Naples Federico II Naples Italy
| | | | | | | | | | - Angela Raucci
- Unit of Experimental Cardio‐Oncology and Cardiovascular Aging Centro Cardiologico Monzino‐IRCCS Milan Italy
| | - Marco Giorgio
- European Institute of Oncology (IEO) Milan Italy
- Department of Biomedical Sciences University of Padova Padua Italy
| | - Paolo Madeddu
- Experimental Cardiovascular Medicine Bristol Medical School: Translational Health Sciences University of Bristol Bristol UK
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5
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Baniak LM, Yang K, Choi J, Chasens ER. Long Sleep Duration Is Associated With Increased Frailty Risk in Older Community-Dwelling Adults. J Aging Health 2020; 32:42-51. [PMID: 30270714 PMCID: PMC6440876 DOI: 10.1177/0898264318803470] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To examine whether sleep duration is correlated with increased frailty risk and investigate the determinants of frailty status. Method: Data on 3,632 participants from the 2011 to 2014 National Health and Nutrition Examination Survey (NHANES, community-dwelling >60 years, 52.1% prefrail, 13.6% frail, 55% women) were used. Frailty status was categorized by Fried Phenotype (robust, prefrail, and frail) with customized criteria for the NHANES data set. Hours of self-reported sleep duration were categorized as short (⩽6), normal (7-9), and long (⩾10). Multinomial regression analysis identified risk factors for each frailty state. Results: Only long sleep duration was associated with increased odds (2.86 [1.09-7.50]) of being characterized as frail but not prefrail. Frail and prefrail states had shared risk factors but also had many distinct to each state. Discussion: Sleep duration is a potential, modifiable therapeutic target for frailty management. Multicomponent interventions should be tailored for frailty status.
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Affiliation(s)
| | - Kyeongra Yang
- Rutgers, The State University of New Jersey, Newark, USA
| | - JiYeon Choi
- University of Pittsburgh, Pittsburgh, USA
- Yonsei University, Seoul, Korea
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6
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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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7
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Marcus-Varwijk AE, Madjdian DS, de Vet E, Mensen MWM, Visscher TLS, Ranchor AV, Slaets JPJ, Smits CHM. Experiences and views of older people on their participation in a nurse-led health promotion intervention: "Community Health Consultation Offices for Seniors". PLoS One 2019; 14:e0216494. [PMID: 31083681 PMCID: PMC6513064 DOI: 10.1371/journal.pone.0216494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/22/2019] [Indexed: 01/15/2023] Open
Abstract
Background The growing number of community-dwelling older adults and the increased risks of adverse health events that accompany ageing, call for health promotion interventions. Nurses often lead these interventions. The views and experiences of older adults participating in these interventions have rarely been studied. To understand the views of targeted older adults, qualitative studies are essential. The aim of this study was to investigate the views and experiences of older adults on their participation in a nurse-led intervention, taking into account their views on healthy aging. Methods In a qualitative study, nineteen Dutch older adults aged 62 to 92 years participated in semi-structured interviews. These were transcribed verbatim and coded with the Qualitative Data Analysis Miner software program. The Qualitative Analysis Guide of Leuven was used for data analysis. Results Based on the analysis of the interviews, the following main themes emerged from the data reflecting the experiences of the participants: 1) awareness of aging, 2) experienced interaction with the nurse, and 3) perception of the consultations as a check-up and/or personal support. Conclusions This study underscores the importance of nurse-led interventions that match older adults’ personal views concerning healthy living, and their views and experiences concerning these interventions. Older adults’ holistic views of healthy living were not always assessed and valued by the nurses. Also, our study shows a wide variety of expectations, views and experiences among the participating older adults. This implies that health professionals should adjust their working and communication methods to the older adult’s views on life.
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Affiliation(s)
- Anne Esther Marcus-Varwijk
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Dónya S. Madjdian
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
- Chair group Strategic Communication, Sub-department of Communication, Philosophy and Technology: Centre for Integrative Development, Wageningen University, Wageningen University and Research, Wageningen, The Netherlands
| | - Emely de Vet
- Chair group Strategic Communication, Sub-department of Communication, Philosophy and Technology: Centre for Integrative Development, Wageningen University, Wageningen University and Research, Wageningen, The Netherlands
| | - Monique W. M. Mensen
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Tommy L. S. Visscher
- Research Group for Healthy Cities, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Adelita V. Ranchor
- Health Psychology Section, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joris P. J. Slaets
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
| | - Carolien H. M. Smits
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
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8
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Coker JF, Martin ME, Simpson RM, Lafortune L. Frailty: an in-depth qualitative study exploring the views of community care staff. BMC Geriatr 2019; 19:47. [PMID: 30782120 PMCID: PMC6381739 DOI: 10.1186/s12877-019-1069-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/13/2019] [Indexed: 12/13/2022] Open
Abstract
Background Frailty is seen across various health and social care settings. However, little is known about how healthcare professionals, particularly those who provide care for older adults living in the community view frailty. There is also a dearth of information about the extent to which a shared understanding of frailty exists across the various disciplines of care. Such an understanding is crucial across care professionals as it ensures consistent assessment of frailty and facilitates interdisciplinary working/collaboration which is a key component in the management of frailty. This study aimed to explore: (i) how community care staff from various specialties viewed frailty; (ii) whether they had a shared understanding; and (iii) how they assessed frailty in everyday practice. Methods Semi-structured interviews were conducted with a purposive sample of 22 community care staff from seven specialties, namely: healthcare assistants, therapy assistants, psychiatric nurses, general nurses, occupational therapists, physiotherapists and social workers, recruited from four neighbourhood teams across Cambridgeshire, England. Interviews were analysed thematically. Results There was a shared narrative among participants that frailty is an umbrella term that encompasses interacting physical, mental health and psychological, social, environmental, and economic factors. However, various specialities emphasised the role of specific facets of the frailty umbrella. The assessment and management of frailty was said to require a holistic approach facilitated by interdisciplinary working. Participants voiced a need for interdisciplinary training on frailty, and frailty tools that facilitate peer-learning, a shared understanding of frailty, and consistent assessment of frailty within and across specialities. Conclusions These findings underscore the need to: (i) move beyond biomedical descriptions of frailty; (ii) further explore the interacting nature of the various components of the frailty umbrella, particularly the role of modifiable factors such as psychological and socioeconomic resilience; (iii) care for frail older adults using holistic, interdisciplinary approaches; and (iv) promote interdisciplinary training around frailty and frailty tools to facilitate a shared understanding and consistent assessment of frailty within and across specialities. Electronic supplementary material The online version of this article (10.1186/s12877-019-1069-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J F Coker
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SR, UK.
| | - M E Martin
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - R M Simpson
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - L Lafortune
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SR, UK
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9
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Palomo I, Giacaman RA, León S, Lobos G, Bustamante M, Wehinger S, Tapia JC, Fuentes M, Alarcón M, García F, Albala C, Fuentes E. Analysis of the characteristics and components for the frailty syndrome in older adults from central Chile. The PIEI-ES study. Arch Gerontol Geriatr 2019; 80:70-75. [DOI: 10.1016/j.archger.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 01/19/2023]
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10
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Walters K, Frost R, Kharicha K, Avgerinou C, Gardner B, Ricciardi F, Hunter R, Liljas A, Manthorpe J, Drennan V, Wood J, Goodman C, Jovicic A, Iliffe S. Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT. Health Technol Assess 2018; 21:1-128. [PMID: 29214975 DOI: 10.3310/hta21730] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING Community settings in London and Hertfordshire, UK. PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, Kingston University and St George's, University of London, London, UK
| | - John Wood
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
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11
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Kapan A, Winzer E, Haider S, Titze S, Schindler K, Lackinger C, Dorner TE. Impact of a lay-led home-based intervention programme on quality of life in community-dwelling pre-frail and frail older adults: a randomized controlled trial. BMC Geriatr 2017; 17:154. [PMID: 28724351 PMCID: PMC5517808 DOI: 10.1186/s12877-017-0548-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/13/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Due to the demographic ageing process and the increasing number of pre-frail and frail individuals, new lifestyle interventions to enhance the quality of life (QoL) in community-dwelling older adults are necessary. Therefore, we performed a randomised controlled trial (RCT) to compare effects of a lay-led home-based physical and nutritional intervention programme with social support alone on different QoL domains in community-dwelling pre-frail and frail older adults. METHODS In this analysis within a RCT (12 weeks), lay volunteers visited one-on-one pre-frail or frail older adults at home twice a week. Participants in the physical training and nutritional intervention (PTN) group performed six strength exercises and discussed main nutritional issues during each visit. The social support (SOSU) group received home visits twice a week for social exchanges. The QoL was assessed with the WHOQOL-BREF and the WHOQOL-OLD instruments. Analyses of covariance (ANCOVA) were used to examine differences between groups with baseline values as the covariate. Changes within groups were assessed with paired t-tests. RESULTS Eighty participants (n = 39 in the PTN group and n = 41 in the SOSU group) were included. No significant differences were found between the two groups except in past, present and future activities domain [β = 3.66 (95% confidence interval 0.13 to 7.18)] in favour of the PTN group. However, there was some evidence of greater within group improvements in the PTN group particularly in overall QoL, social relations and social participation. In the SOSU group, no significant effect was observed in any QoL domain. CONCLUSION A combination of a home-based physical and nutritional intervention was not more effective compared to social support alone, on QoL in community-dwelling pre-frail and frail older adults. However, the small but significant improvement within the PTN group suggests that a home-based physical and nutritional intervention delivered by volunteers may influence the QoL in a positive way. TRIAL REGISTRATION The study protocol was registered on 6 November 2013 at ClinicalTrials.gov (identifier: NCT01991639 ).
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Affiliation(s)
- A Kapan
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - E Winzer
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - S Haider
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - S Titze
- Institute of Sport Science, University of Graz, Graz, Austria
| | - K Schindler
- Division of Endocrinology and Metabolism, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - C Lackinger
- Department of Health Promotion and Prevention, Sportunion Austria, Vienna, Austria
| | - T E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
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12
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Puts MTE, Toubasi S, Andrew MK, Ashe MC, Ploeg J, Atkinson E, Ayala AP, Roy A, Rodríguez Monforte M, Bergman H, McGilton K. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age Ageing 2017; 46:383-392. [PMID: 28064173 PMCID: PMC5405756 DOI: 10.1093/ageing/afw247] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background frailty impacts older adults' ability to recover from an acute illness, injuries and other stresses. Currently, a systematic synthesis of available interventions to prevent or reduce frailty does not exist. Therefore, we conducted a scoping review of interventions and international policies designed to prevent or reduce the level of frailty in community-dwelling older adults. Methods and analysis we conducted a scoping review using the framework of Arksey and O'Malley. We systematically searched articles and grey literature to identify interventions and policies that aimed to prevent or reduce the level of frailty. Results fourteen studies were included: 12 randomised controlled trials and 2 cohort studies (mean number of participants 260 (range 51-610)), with most research conducted in USA and Japan. The study quality was moderate to good. The interventions included physical activity; physical activity combined with nutrition; physical activity plus nutrition plus memory training; home modifications; prehabilitation (physical therapy plus exercise plus home modifications) and comprehensive geriatric assessment (CGA). Our review showed that the interventions that significantly reduced the number of frailty markers present or the prevalence of frailty included the physical activity interventions (all types and combinations), and prehabilitation. The CGA studies had mixed findings. Conclusion nine of the 14 studies reported that the intervention reduced the level of frailty. The results need to be interpreted with caution, as only 14 studies using 6 different definitions of frailty were retained. Future research could combine interventions targeting more frailty markers including cognitive or psychosocial well-being.
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Affiliation(s)
- Martine T. E Puts
- University of Toronto—Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Samar Toubasi
- University of Toronto—Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Melissa K. Andrew
- Dalhousie University—Division of Geriatric Medicine, Halifax, Nova Scotia, Canada
| | - Maureen C. Ashe
- University of British Columbia—Family Practice, Vancouver, British Columbia V5Z 1M9, Canada
- University of British Columbia—Centre for Hip Health and Mobility -7 F-2635 Laurel St., Vancouver, British Columbia V5Z 1M9, Canada
| | - Jenny Ploeg
- McMaster University—School of Nursing, Hamilton, Ontario, Canada
| | - Esther Atkinson
- University of Toronto—Gerstein Information Science, Toronto, Ontario, Canada
| | - Ana Patricia Ayala
- University of Toronto—Gerstein Information Science Centre, Toronto, Ontario, Canada
| | - Angelique Roy
- University Health Network—Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Howard Bergman
- Department of Family Medicine, McGill University—Geriatric Medicine, Montréal, Canada
| | - Kathy McGilton
- University Health Network—Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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