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Canet-Vélez O, Solis-Navarro L, Sitjà-Rabert M, Pérez LM, Roca J, Soto-Bagaria L, Torres-Castro R, Díaz-Gallego F, Vilaró J, Inzitari M. Experience, facilitators, and barriers to the implementation of a multicomponent programme in older people living in the community, +AGIL Barcelona: A qualitative study. Front Public Health 2023; 11:1161883. [PMID: 37064681 PMCID: PMC10097946 DOI: 10.3389/fpubh.2023.1161883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
IntroductionThe +AGIL Barcelona programme is a multicomponent care intervention for frail older adults (FOAs) living in the community. To improve the programme, it is essential to investigate the experience of all participants. Our objective was to explore the perspective of FOA and professionals about the barriers, facilitators, and improvement elements of the development of the +AGIL Barcelona programme. Qualitative descriptive approach. Were included FOA and professionals who participated in the +AGIL Barcelona programme.MethodsThree focus groups and four interviews were conducted. These were analyzed following the qualitative method of content analysis. The criteria of scientific rigor of credibility, dependence, and transferability were ensured throughout the study.ResultsThree themes and seven sub-themes were developed: facilitators (positive experience and perceived benefits), barriers (self-perceived health status, digital divide, and continuity of the programme at home), and improvements elements (programme continuity and adaptation of technology). All the participants felt satisfied, highlighting aspects such as interpersonal relationships and social contact, face-to-face sessions guided by a physiotherapist, and the functional improvement achieved. Some of the difficulties were the self-perception of frailty, the need for technological support, and continuing the exercise programme at home.ConclusionThe FOA who participated in the +AGIL Barcelona programme perceived direct benefits for their health and physical condition due to the development of self-confidence by being able to perform physical exercise despite their baseline condition, and the professionals experienced an improvement in the quality of care due to work in a multidisciplinary team.
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Affiliation(s)
- Olga Canet-Vélez
- Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Research Group Global Health, Gender and Society (GHenderS), Barcelona, Spain
| | - Lilian Solis-Navarro
- Programa de Doctorat-Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Barcelona, Spain
| | - Mercè Sitjà-Rabert
- Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Barcelona, Spain
- *Correspondence: Mercè Sitjà-Rabert
| | - Laura Mónica Pérez
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Luis Soto-Bagaria
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain
| | | | - Francisco Díaz-Gallego
- Institut Català de la Salut, Gerència de Barcelona, Barcelona, Spain
- Primary Healthcare Center Bordeta-Magòria, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Vilaró
- Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Barcelona, Spain
| | - Marco Inzitari
- Research on Aging, Frailty and Care Transitions in Barcelona (REFiT-BCN), Parc Sanitari Pere Virgili and Vall d'Hebron Institute (VHIR), Barcelona, Spain
- Faculty of Health Sciences and eHealth Center, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Swan L, Martin N, Horgan NF, Warters A, O’Sullivan M. Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults-An Exploratory Home-Based Study of an Underserved Group in Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16133. [PMID: 36498213 PMCID: PMC9736424 DOI: 10.3390/ijerph192316133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adults of advanced age, with functional dependency, socioeconomic disadvantage, or a need for home care, are expected to be at high risk of sarcopenia, frailty and malnutrition, yet are likely to be underrepresented in research. We aimed to explore the assessment of sarcopenia, frailty, and malnutrition in-home, and to describe the practicality of performing these assessments. METHODS Home-based health assessments and post-study feedback surveys were conducted among community-dwelling older adults ≥65 years in receipt of state-funded home care (n = 31). Assessments included probable sarcopenia [hand-grip strength (HGS), chair rise-test, and SARC-F case-finding tool], the Mini Nutritional Assessment (MNA), and the Clinical Frailty Scale (CFS). RESULTS The study group was of mean age 83.2 ± 8.2 years, 74% were female and 23% lived in socioeconomically disadvantaged areas. Almost all met the criteria for probable sarcopenia (94%, n = 29/31), were frail or vulnerable by the CFS (97%, n = 30/31), and over a quarter were at risk of malnutrition (26%, n = 8). Participants had low physical activity (71.0%, n = 22/31), with a mean daytime average of 11.4 ± 1.6 h spent sitting. It was possible to assess probable sarcopenia (by HGS and SARC-F, but not the chair rise test), malnutrition (MNA), and frailty (CFS). Home-based research was a complex environment, and unearthed significant unmet need, prompting referrals to health services (36%, n = 11), in addition to technology assistance. The majority of participants (93%) reported a willingness to partake in future research. CONCLUSIONS Most community-dwelling older people in receipt of home support, assessed in this exploratory study, were at risk of probable sarcopenia, frailty, and low physical activity, with over a quarter were at risk of malnutrition. Our initial findings provide practical data for large scale studies and may inform the development of intervention studies aiming to support ageing in place.
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Affiliation(s)
- Lauren Swan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - Niamh Martin
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
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Faria ADCA, Martins MMFPS, Ribeiro OMPL, Ventura-Silva JMA, Fonseca EF, Ferreira LJM, Teles PJFC, Laredo-Aguilera JA. Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14723. [PMID: 36429441 PMCID: PMC9691079 DOI: 10.3390/ijerph192214723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.
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Affiliation(s)
- Ana da Conceição Alves Faria
- Abel Salazar Biomedical Sciences Institute, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
- North Region Health Administration, 4000-447 Porto, Portugal
- CINTESIS@RISE, 4050-313 Porto, Portugal
| | | | | | - João Miguel Almeida Ventura-Silva
- Abel Salazar Biomedical Sciences Institute, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
- Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | | | | | - Paulo João Figueiredo Cabral Teles
- School of Economics, University of Porto, 4200-465 Porto, Portugal
- Laboratory of Artificial Intelligence and Decision Support—INESC Porto LA, 4200-465 Porto, Portugal
| | - José Alberto Laredo-Aguilera
- Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain
- Multidisciplinary Research Group in Care (IMCU), University of Castilla-La Mancha, 45005 Toledo, Spain
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Horgan F, Cummins V, Skelton DA, Doyle F, O’Sullivan M, Galvin R, Burton E, Sorensen J, Jabakhanji SB, Townley B, Rooney D, Jackson G, Murphy L, Swan L, O’Neill M, Warters A. Enhancing Existing Formal Home Care to Improve and Maintain Functional Status in Older Adults: Results of a Feasibility Study on the Implementation of Care to Move (CTM) in an Irish Healthcare Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11148. [PMID: 36141422 PMCID: PMC9517683 DOI: 10.3390/ijerph191811148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Background: Care to Move (CTM) provides a series of consistent 'movement prompts' to embed into existing movements of daily living. We explored the feasibility of incorporating CTM approaches in home care settings. Methods: Feasibility study of the CTM approach in older adults receiving home care. Recruitment, retention and attrition (three time points), adherence, costs to deliver and data loss analyzed and differentiated pre and post the COVID-19 pandemic. Secondary outcomes, including functional status, physical activity, balance confidence, quality of life, cost to implement CTM. Results: Fifty-five home care clients (69.6% of eligible sample) participated. Twenty were unable to start due to COVID-19 disruptions and health issues, leaving 35 clients recruited, mostly women (85.7%), mean age 82.8 years. COVID-19 disruption impacted on the study, there was 60% retention to T2 assessments (8-weeks) and 13 of 35 (37.1%) completed T3 assessments (6-months). There were improvements with small to medium effect sizes in quality of life, physical function, balance confidence and self-efficacy. Managers were supportive of the roll-out of CTM. The implementation cost was estimated at EUR 280 per carer and annual running costs at EUR 75 per carer. Conclusion: Embedding CTM within home support services is acceptable and feasible. Data gathered can power a definitive trial.
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Affiliation(s)
- Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Vanda Cummins
- Primary Care Physiotherapy Services CHO9, Health Service Executive, D09 C8P5 Dublin, Ireland
| | - Dawn A. Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - Rose Galvin
- Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick (UL), V94 T9PX Limerick, Ireland
| | - Elissa Burton
- School of Allied Health, Curtin University, Bentley, WA 6102, Australia
- enAble Institute, Curtin University, Bentley, WA 6102, Australia
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Samira Barbara Jabakhanji
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Bex Townley
- Later Life Training, Killin, Scotland FK21 8UT, UK
| | - Debbie Rooney
- North Dublin Home Care (NDHC), D03 A6Y0 Dublin, Ireland
| | - Gill Jackson
- North Dublin Home Care (NDHC), D03 A6Y0 Dublin, Ireland
| | - Lisa Murphy
- North Dublin Home Care (NDHC), D03 A6Y0 Dublin, Ireland
| | - Lauren Swan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - Mary O’Neill
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
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Aprahamian I, Borges MK, Hanssen DJC, Jeuring HW, Oude Voshaar RC. The Frail Depressed Patient: A Narrative Review on Treatment Challenges. Clin Interv Aging 2022; 17:979-990. [PMID: 35770239 PMCID: PMC9234191 DOI: 10.2147/cia.s328432] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Although the public importance of frailty is widely acknowledged by the World Health Organization, physical frailty is still largely neglected in geriatric mental health care. Firstly in this narrative review, we summarize the knowledge on the epidemiology of the association between depression and frailty, whereafter implications for treatment will be discussed. Even though frailty and depression have overlapping diagnostic criteria, epidemiological studies provide evidence for distinct constructs which are bidirectionally associated. Among depressed patients, frailty has predictive validity being associated with increased mortality rates and an exponentially higher fall risk due to antidepressants. Nonetheless, guidelines on the treatment of depression neither consider frailty for risk stratification nor for treatment selection. We argue that frailty assessment enables clinicians to better target the pharmacological and psychological treatment of depression as well as the need for interventions targeting primarily frailty, for instance, lifestyle interventions and reduction of polypharmacy. Applying a frailty informed framework of depression treatment studies included in a meta-analysis reveals that the benefit–harm ratio of antidepressants given to frail depressed patients can be questioned. Nonetheless, frail-depressed patients should not withhold antidepressants as formal studies are not available yet, but potential adverse effects should be closely monitored. Dopaminergic antidepressants might be preferable when slowness is a prominent clinical feature. Psychotherapy is an important alternative for pharmacological treatment, especially psychotherapeutic approaches within the movement of positive psychology, but this approach needs further study. Finally, geriatric rehabilitation, including physical exercise and nutritional advice, should also be considered. In this regard, targeting ageing-related abnormalities underlying frailty that may also be involved in late-life depression such as low-grade inflammation might be a promising target for future studies. The lack of treatment studies precludes firm recommendations, but more awareness for frailty in mental health care will open a plethora of alternative treatment options to be considered.
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Affiliation(s)
- Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
- Correspondence: Ivan Aprahamian, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, Jundiaí, Brazil, Email
| | - Marcus K Borges
- Federal University of Paraná, Department of Psychiatry, Curitiba, Brazil
| | - Denise J C Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Hans W Jeuring
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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