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Wang Y, Shen S, Han P, Zheng K, Chen C, Wu Y, Huang C, Guo J, Qi Y, Chen X, Zheng Y, Xia X, Peng S, Guo Q. The association between visceral fat obesity and prefrailty in Chinese older adults: a cross-sectional study. BMC Endocr Disord 2024; 24:136. [PMID: 39090692 PMCID: PMC11295587 DOI: 10.1186/s12902-024-01625-1] [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] [Received: 03/11/2024] [Accepted: 06/14/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The prevalence of obesity is escalating. Previous research has concentrated on the link between frailty and obesity; however, the association between prefrailty and obesity has been less studied. Prefrailty screening and intervention may prevent or postpone frailty in older persons. OBJECTIVE The study was to investigate into the relationship between prefrailty and several obesity indicators in Chinese community-dwelling older individuals. METHODS This research employed the Frailty Screening Index to investigate the frailty phenotype of people living in Shanghai. Bioelectrical impedance analysis was used for evaluating body composition. RESULTS There were 510 participants (39.0%) with high visceral adipose areas. Participants with a high visceral adipose area showed a higher risk of prefrailty (adjusted OR, 1.53; 95% CI, 1.19-1.96), according to multivariate models. When body mass index (BMI) and visceral fat area (VFA) were combined, it was discovered that having an overweight BMI with normal VFA was a protective factor for prefrailty (corrected OR, 0.62; 95% CI, 0.43-0.90), but having a normal weight but excess VFA increased the risk of prefrailty (corrected OR, 1.87; 95% CI, 1.15-3.03). CONCLUSION Visceral fat obesity is an independent risk factor for prefrailty in Chinese older adults. Implementing targeted interventions, such as dietary modifications, increased physical activity, and other lifestyle changes, could play a crucial role in reducing the risk of prefrailty and improving overall health outcomes in this population.
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Affiliation(s)
- Yue Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Suxing Shen
- Rehabilitation Medicine Department, Tianjin Fifth Central Hospital, Tianjin, 300457, China
| | - Peipei Han
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Kai Zheng
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Cheng Chen
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- School of Health, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Yahui Wu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Chuanjun Huang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200135, China
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jiangling Guo
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yiqiong Qi
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China
| | - Xiaoyu Chen
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Yuxuan Zheng
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Xinwei Xia
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Siyan Peng
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Qi Guo
- Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China.
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China.
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Barghouth MH, Klein J, Bothe T, Ebert N, Schaeffner E, Mielke N. Social support and frailty progression in community-dwelling older adults. Front Public Health 2024; 12:1408641. [PMID: 39086799 PMCID: PMC11288939 DOI: 10.3389/fpubh.2024.1408641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives Despite the growing evidence regarding the influence of social factors on frailty in older adults, the effect of social support remains unclear. This study aims to assess the association between social support and frailty progression (transition and incidence) in a sample of community-dwelling older adults. Methods Using a cohort study design, 1,059 older adults from the Berlin Initiative Study were followed up for 2.1 years. Multinomial and logistic regression analyses were performed to assess the association of social support using Oslo Social Support Scale-3 with frailty transition and incidence, respectively. Gender differences were explored using stratified analyses. Results At baseline, frailty prevalence in the study population [mean (SD) age 84.3 (5.6) years; 55.8% women] reached 33.1% with 47.0, 29.4 and 23.6% of the participants reporting moderate, strong and poor social support, respectively. Over the follow-up period, social support was not significantly associated with the frailty transition categories in the adjusted model. Conversely, the adjusted logistic regression analysis showed that participants with poor social support had twice the odds of becoming frail compared to those with strong social support (OR 2.07; 95% CI 1.08-3.95). Gender-stratified analyses showed comparable estimates to the main analysis but were statistically non-significant. Discussion Our study results underpin the role of social factors in frailty incidence and highlight social support as a potential target for frailty-preventing interventions in older adults. Therefore, it is important to adopt a biopsychosocial model rather than a purely biomedical model to understand and holistically improve the health of community-dwelling older adults.
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Affiliation(s)
- Muhammad Helmi Barghouth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Jessica Klein
- Department of Social Policy and Social Security Studies, Hochschule Bonn-Rhein-Sieg, Sankt Augustin, Germany
| | - Tim Bothe
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Nina Mielke
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Yuan M, Zhang Y, Hu R, Yuan L, Ma J, Xu Y. Linear-inverse associations of serum Klotho protein with prevalence of frailty among adults in the United States. Am J Transl Res 2024; 16:3090-3098. [PMID: 39114692 PMCID: PMC11301489 DOI: 10.62347/ozhf3072] [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: 04/04/2024] [Accepted: 05/17/2024] [Indexed: 08/10/2024]
Abstract
AIMS To investigate the potential linear relationship between serum concentrations of klotho and frailty. METHODS A retrospective analysis was conducted on the data of 9,597 middle-aged and older adults (aged 40-79 years) from the five cycles of the National Health and Nutrition Examination Survey (NHANES). Frailty was assessed using the Frailty Index, calculated as a percentage of accumulated deficits across 53 health items. Restricted cubic spline curves, subgroup analyses and logistic regression models were employed to evaluate the specific linear trend connection between circulating klotho protein concentration and frailty. RESULTS When taking Klotho into account as a continuous component in Models 1 and 2, there was a substantial association between the increasing Klotho level and the reduced risk of frailty. Model 3 revealed a strong negative correlation between the Klotho and Frailty, suggesting that high levels of Klotho protein decreases the frailty prevalence [Odd ratio (OR): 0.25; 95% confidence interval (CI): 0.15-0.43]. Furthermore, according to the quartile analyses, after fully adjusting for the covariates, it was observed that, comparing to the lowest quartile of Klotho, the highest quartile of Klotho demonstrated lowest risk of frailty (OR 0.69; 95% CI 0.58-0.81, Ptrend < 0.001). The restricted cubic spline curves showed a linear relationship and an inverse association between frailty and the Klotho levels (Plinearity < 0.001; Pnon-linearity = 0.736). CONCLUSION Klotho is inversely and linearly associated with physical frailty in the general population (aged 40-79 years), specifically in the population with an age < 65 and body mass index (BMI) ≥ 25 kg/m2. More necessary prospective studies should be done to further investigate the mechanisms underlying frailty and aging and to elucidate individual frailty causes.
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Affiliation(s)
- Menghan Yuan
- Department of Cardiology, Medical School of Chinese PLABeijing 100853, China
- Senior Department of Cardiology, The Sixth Medical Center of PLA General HospitalBeijing 100048, China
| | - Yingyue Zhang
- Department of Cardiology, Medical School of Chinese PLABeijing 100853, China
- Senior Department of Cardiology, The Sixth Medical Center of PLA General HospitalBeijing 100048, China
| | - Rong Hu
- Department of Cardiology, Medical School of Chinese PLABeijing 100853, China
- Senior Department of Cardiology, The Sixth Medical Center of PLA General HospitalBeijing 100048, China
| | - Lin Yuan
- Senior Department of Cardiology, The Sixth Medical Center of PLA General HospitalBeijing 100048, China
| | - Jing Ma
- Department of Cardiology, The First Medical Center of Chinese PLA General HospitalBeijing 100853, China
| | - Yong Xu
- Department of Cardiology, Medical School of Chinese PLABeijing 100853, China
- Senior Department of Cardiology, The Sixth Medical Center of PLA General HospitalBeijing 100048, China
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Sattar S, Haase KR, Lee K, Campbell KL. Exercise interventions for frail older adults with cancer. Curr Opin Support Palliat Care 2024; 18:22-26. [PMID: 38126248 DOI: 10.1097/spc.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Frailty is prevalent in older adults with cancer and can lead to complications during cancer treatment and poor health outcomes. Exercise has been shown to be a promising strategy to mitigate frailty and slow the accumulation of functional impairment in the general geriatric population. In this review, we present a discussion on the state of the science of exercise interventions for frail older adults with cancer. This review is timely and relevant given the aging of the population and corresponding increase in proportion of older adults living with cancer. RECENT FINDINGS Existing research related to exercise interventions for frail older adults with cancer appear to show some promise in feasibility and efficacy in both surgical and systemic treatment settings. SUMMARY More research on this topic and testing rigorously structured exercise interventions for older adults with cancer may help inform cancer-specific guidelines and create a foundation of evidence to enable implementation of exercise interventions. These interventions can support cancer care to attenuate frailty-related outcomes while extending its benefit to overall health of this population.
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Affiliation(s)
- Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia
- BC Cancer Research Institute, Cancer Control
| | - Kayoung Lee
- Faculty of Applied Science, School of Nursing, University of British Columbia
| | - Kristin L Campbell
- BC Cancer Research Institute, Cancer Control
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Kasa AS, Drury P, Chang HC(R, Lee SC, Traynor V. Measuring the effects of a nurse-led intervention on frailty status of older people living in the community in Ethiopia: A protocol for a quasi-experimental study. PLoS One 2024; 19:e0296166. [PMID: 38241265 PMCID: PMC10798498 DOI: 10.1371/journal.pone.0296166] [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: 07/08/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The recent recognition of the multidimensional features of frailty has emphasised the need for individualised multicomponent interventions. In the context of sub-Saharan Africa, few studies have examined: a) the frailty status of the older population; b) the level of frailty and its health implications and; c) the impact of a nurse-led intervention to reduce frailty. OBJECTIVES This study aims to design, implement, and evaluate a nurse-led intervention to reduce frailty and associated health consequences among older people living in Ethiopia. METHODS The study will be conducted on 68 older persons using a pre-, post-, and follow-up single-group quasi-experimental design. Residents of Ethiopia, ≥60 years and living in the community will be invited to participate in a 24-week program designed to decrease frailty and associated health consequences. Data will be collected at three-time points: baseline, immediately after the intervention, and 12 weeks post-intervention. To determine the effect of the intervention, changes in frailty, nutritional status, activities of daily living, depression and quality of life scores will be measured. To measure the effect of a nurse-led intervention on the level of frailty among older people a generalised linear model (GLM) using repeated measures ANOVA will be used. Statistical significances will be set at p-values < 0.05. DISCUSSION The results of this study will determine the impact of a nurse-led intervention to reduce frailty amongst community-dwelling older people living in Ethiopia. The results of this study will inform the development of future interventions designed to reduce frailty in lower-income countries. TRIAL REGISTRATION The trial was registered in ClinicalTrials.gov with the identifier of NCT05754398.
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Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
| | - Hui-Chen (Rita) Chang
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, New South Wales, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
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Walters K, Armstrong M, Gardner B, Ambler G, Hunter R, Maydon B, Davies N, Atkinson C, Brown R, Rookes T, Davis D, Schrag A. Clinical and cost-effectiveness of 'Live Well with Parkinson's' self-management intervention versus treatment as usual for improving quality of life for people with Parkinson's: study protocol for a randomised controlled trial. Trials 2023; 24:793. [PMID: 38053209 DOI: 10.1186/s13063-023-07700-7] [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: 07/21/2023] [Accepted: 10/04/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The Live Well with Parkinson's Self-Management Toolkit is designed for use in the NHS to support people with Parkinson's, their carers and health professionals in managing motor and non-motor symptoms and promoting well-being. The Toolkit was developed based on theory-based behaviour change and self-management techniques in consultation with people living with Parkinson's and health and social care practitioners. There are digital (e-Toolkit) and paper (manual) versions. METHODS Single-blind two-arm randomised controlled trial RCT of clinical effectiveness and cost-effectiveness of the Toolkit, facilitated by up to six sessions with a trained non-specialist supporter, in improving quality of life. People with Parkinson's will be assessed at baseline, 6 and 12 months. Assessors will be blind to the treatment group. The primary outcome measure is the Parkinson's Disease Questionnaire (PDQ-39, Parkinson's related quality of life) score at 12 months. Secondary outcome measures include the MDS Unified Parkinson's Disease Rating Scale (Part I, II, III, IV), EQ-5D, and a Client Service Receipt Inventory shortened, adapted for Parkinson's. Carer outcomes include the Zarit Carer Burden Inventory and Carer Quality of Life Questionnaire for Parkinsonism. A total of 338 people with Parkinson's, and their carers if appropriate, will be recruited from diverse settings across England. Those with advanced dementia, at end-of-life or with atypical Parkinsonism will be excluded. A parallel mixed methods process evaluation will explore the factors promoting or inhibiting implementation, uptake, use, effectiveness and cost-effectiveness of the Toolkit and sessions. DISCUSSION If successful, the Live Well with Parkinson's Toolkit could be used as a model for other complex long-term disorders, including dementia. This would bridge existing gaps in the NHS (as shown by the national Parkinson's audit data), by enabling patients and carers to access personalised information, advice and support on symptom management and 'living well' with Parkinson's. TRIAL REGISTRATION ISRCTN92831552. Registered on 26th Oct 2021.
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Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Megan Armstrong
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | | | - Gareth Ambler
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Bev Maydon
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Nathan Davies
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | | | - Richard Brown
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tasmin Rookes
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
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Sun X, Gao Y, Chen Y, Qin L, Lin Y, Song J, Zhang Z, Wang H, Feng H, Tan H, Chen Q, Peng L, Dai W, Wu IXY. Development and validation of frailty and malnutrition knowledge assessment scale for community-dwelling older adults. Appl Physiol Nutr Metab 2023; 48:974-1004. [PMID: 37669568 DOI: 10.1139/apnm-2023-0141] [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] [Indexed: 09/06/2023]
Abstract
There is a lack of reliable tools to assess the knowledge of frailty and malnutrition in community-dwelling older adults. To develop and validate reliable frailty and malnutrition knowledge assessment scales for this population, two scales were developed and validated through five phases. Phase 1: the item pools were constructed through a literature review and research panel based on the symptom interpretation model. Phase 2: the expert consultation was performed to select the items. Phase 3: a pilot survey was conducted to assess the clarity of the items and further revise the scales. Phase 4: 242 older adults were surveyed to finalize the items. Phase 5: 241 older adults were surveyed to test the psychometric properties. The two scales each comprise 3 dimensions (symptoms, risk factors, and management strategies) and 11 items. They had good construct validity, with all indicators of correlation analysis and confirmatory factor analysis meeting their specific criteria. The reliability of the frailty and malnutrition knowledge assessment scales was good, with composite reliability coefficients all >0.60, Cronbach's alpha being 0.81 and 0.83, and the Spearman-Brown coefficient being 0.74 and 0.80, respectively. Their acceptability was good, with both having a completion rate of 92.18% and an average completion time of 3 min. The two scales are reliable tools to assess the knowledge of frailty and malnutrition among community-dwelling older adults, especially for large-scale surveys. They can help identify knowledge gaps in older adults and provide a basis for developing targeted educational interventions.
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Affiliation(s)
- Xuemei Sun
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Yinyan Gao
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Yancong Chen
- Changsha Municipal Center for Disease Control and Prevention, Changsha, China
| | - Lang Qin
- Sinocare Inc., No. 265 Guyuan Road Hi-tech Zone, Changsha, Hunan, China
| | - Yali Lin
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Jinlu Song
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Zixuan Zhang
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Huan Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha, China
| | - Hongzhuan Tan
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Qiong Chen
- Xiangya Hospital of Central South University, Changsha, China
| | - Linlin Peng
- Xiangya Hospital of Central South University, Changsha, China
| | - Wenjie Dai
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Irene X Y Wu
- Xiangya School of Public health, Central South University, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
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Money A, Harris D, Hawley-Hague H, McDermott J, Vardy E, Todd C. Acceptability of physical activity signposting for pre-frail older adults: a qualitative study to inform intervention development. BMC Geriatr 2023; 23:621. [PMID: 37789276 PMCID: PMC10548637 DOI: 10.1186/s12877-023-04202-8] [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: 03/24/2023] [Accepted: 07/28/2023] [Indexed: 10/05/2023] Open
Abstract
Frailty is a medical condition common in older adults characterised by diminished strength and reduced physiologic function in which individuals are more vulnerable to multiple adverse health outcomes. Pre-frailty is an intermediate stage associated with some minor health outcomes. However, the main risk is progression toward moderate/severe frailty. Evidence shows physical activity interventions to be effective in slowing or modifying the progression of frailty. Researchers at the University of Manchester are developing a behaviour change intervention targeting pre-frail older adults, signposting them to group-based physical activity classes known to be effective for delaying/slowing frailty. This paper reports on the initial intervention development work with key stakeholders exploring the practicality of taking forward this intervention and identifying uncertainties to be explored in the feasibility stage. These included issues around physical activity messaging, the use of the term 'frail', identification/recruitment of pre-frail older adults, and the acceptability of behaviour change techniques. There was overwhelming support for a proactive approach to addressing pre-frailty issues. Given that a large proportion of older adults are estimated to be pre-frail, interventions aimed at this group have the potential to support healthy ageing, positively impacting on frailty outcomes and providing wider population health benefits.
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Affiliation(s)
- Annemarie Money
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK.
| | - Danielle Harris
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Helen Hawley-Hague
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, M13 9PL, UK
| | - Jane McDermott
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Emma Vardy
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, M13 9PL, UK
- Northern Care Alliance NHS Foundation Trust, Salford, M6 8HD, UK
| | - Chris Todd
- National Institute for Health and Care Research, Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, M13 9PL, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
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Ho L, Malden S, McGill K, Shimonovich M, Frost H, Aujla N, Ho ISS, Shenkin SD, Hanratty B, Mercer SW, Guthrie B. Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis. Age Ageing 2023; 52:afad132. [PMID: 37505991 PMCID: PMC10378722 DOI: 10.1093/ageing/afad132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. OBJECTIVE to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults' independent living and quality of life (QoL). METHODS we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00-1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77-0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02-0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01-0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03-0.13). CONCLUSIONS complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs.
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Affiliation(s)
- Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen Malden
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kris McGill
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Michal Shimonovich
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Helen Frost
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Navneet Aujla
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Iris S-S Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susan D Shenkin
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
- Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
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Adekpedjou R, Léon P, Dewidar O, Al‐Zubaidi A, Jbilou J, Kaczorowski J, Muscedere J, Hirdes J, Heckman G, Girard M, Hébert PC. Effectiveness of interventions to address different types of vulnerabilities in community-dwelling older adults: An umbrella review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1323. [PMID: 37180567 PMCID: PMC10168691 DOI: 10.1002/cl2.1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Frailty, social isolation, loneliness, and poverty may render older adults vulnerable to social or health stressors. It is imperative to identify effective interventions to address them especially in the context of COVID-19 pandemic. Objective To identify effective community-based interventions to address frailty, social isolation, loneliness, and poverty among community-dwelling older adults. Design Umbrella review. Data Source We systematically searched PubMed, Ovid MEDLINE, Embase, Cochrane CENTRAL, EBM-Reviews, CINAHL via EBSCO, and APA PsycInfo via Ovid from January 2009 to December 2022. Eligibility Criteria We included systematic reviews or quantitative reviews of non-pharmacologic interventions targeting community-dwelling older adults. Data Selection Extraction and Management Two review authors independently screened the titles and abstracts, performed data extraction and appraised the methodological quality of the reviews. We used a narrative synthesis approach to summarize and interpret the findings. We assessed the methodological quality of the studies using AMSTAR 2.0 tool. Results We identified 27 reviews incorporating 372 unique primary studies that met our inclusion criteria. Ten of the reviews included studies conducted in low-middle-income countries. Twelve reviews (46%, 12/26) included interventions that addressed frailty. Seventeen reviews (65%, 17/26) included interventions that addressed either social isolation or loneliness. Eighteen reviews included studies with single component interventions, while 23 reviews included studies with multi-component interventions. Interventions including protein supplementation combined with physical activity may improve outcomes including frailty status, grip strength, and body weight. Physical activity alone or in combination with diet may prevent frailty. Additionally, physical activity may improve social functioning and interventions using digital technologies may decrease social isolation and loneliness. We did not find any review of interventions addressing poverty among older adults. We also noted that few reviews addressed multiple vulnerabilities within the same study, specifically addressed vulnerability among ethnic and sexual minority groups, or examined interventions that engaged communities and adapted programs to local needs. Conclusion Evidence from reviews support diets, physical activity, and digital technologies to improve frailty, social isolation or loneliness. However, interventions examined were primarily conducted under optimal conditions. There is a need for further interventions in community settings and conducted under real world settings in older adults living with multiple vulnerabilities.
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Affiliation(s)
- Rhéda Adekpedjou
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Pascale Léon
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - Omar Dewidar
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Ali Al‐Zubaidi
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - Janusz Kaczorowski
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
| | - John Muscedere
- Department of Critical Care MedicineQueens University and Canadian Frailty NetworkKingstonOntarioCanada
| | - John Hirdes
- Centre de formation médicale du Nouveau‐Brunswick et École de psychologie, Faculté des sciences de la santé et des services communautairesUniversité de MonctonNouveau‐BrunswickCanada
| | - George Heckman
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada
- Schlegel Research Institute for AgingWaterlooCanada
| | - Magali Girard
- Bureau de Recherche Développement ValorisationUniversité de MontréalMontréalCanada
| | - Paul C. Hébert
- Carrefour de l'innovation et de l'évaluation en santéCentre Hospitalier de l'Université de MontréalMontréalCanada
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
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Duan Y, Qi Q, Cui Y, Yang L, Zhang M, Liu H. Effects of dietary diversity on frailty in Chinese older adults: a 3-year cohort study. BMC Geriatr 2023; 23:141. [PMID: 36918767 PMCID: PMC10012609 DOI: 10.1186/s12877-023-03875-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Frailty has emerged as a global health burden with increased population aging. A diverse diet is essential for an adequate and balanced supply of nutrients. However, limited evidence supports the relationship between dietary diversity and frailty. We therefore assessed the associations of dietary diversity with the risk of frailty. METHODS We used the Chinese Longitudinal Healthy Longevity Survey to analyze a prospective cohort of Chinese older adults. A total of 1948 non-frail older adults were included in the final sample. Participants were categorized into groups with high or low dietary diversity scores (DDSs) using a food frequency questionnaire. A Generalized Estimating Equation were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for determining frailty incidence. RESULTS Among 1,948 participants, 381 had frailty with the prevalence of 19.56% during the 3-year follow-up period. Compared with the low DDS group, the high DDS group exhibited a lower risk of frailty (RR, 0.72; 95% CI: 0.57-0.91). Compared with those with a consistently low DDS, the RR of participants with a consistently high DDS for frailty was 0.56 (95% CI: 0.42-0.74). Moreover, meat, beans, fish, nuts, fresh fruits, and fresh vegetables were inversely associated with frailty. In stratified analysis, a consistently high DDS, compared with a consistently low DDS, reduced the risk of frailty for people aged 65-79 years and those living in town and rural areas. CONCLUSION This study found a prospective association between dietary diversity and frailty among Chinese older adults. These findings stressed that it is important to improve dietary diversity for older adults to promote healthy ageing, particularly for young older adults and in town and rural areas.
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Affiliation(s)
- Ying Duan
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Qi Qi
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Yan Cui
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Ling Yang
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Min Zhang
- School of Health Management, Bengbu Medical College, Bengbu, Anhui, China
| | - Huaqing Liu
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China.
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12
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Heaton J, Singh S, Nanavaty D, Okoh AK, Kesanakurthy S, Tayal R. Impact of frailty on outcomes in acute ST-elevated myocardial infarctions undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2023; 101:773-786. [PMID: 36806859 PMCID: PMC10082419 DOI: 10.1002/ccd.30595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/14/2022] [Accepted: 01/28/2023] [Indexed: 02/21/2023]
Abstract
AIMS We analyzed the impact of frailty on readmission rates for ST-elevated myocardial infarctions (STEMIs) and the utilization of percutaneous coronary intervention (PCI) in STEMI admissions. METHODS AND RESULTS The 2016-2019 Nationwide Readmission Database was analyzed for patients admitted with an acute STEMI. Patients were categorized by frailty risk and analyzed for 30-day readmission risk after acute STEMIs, PCI utilization and outcomes, and healthcare resource utilization. Qualifying index admissions were found in 584,918 visits. Low risk frailty was noted in 78.20%, intermediate risk in 20.67%, and high risk in 1.14% of admissions. Thirty-day readmissions occurred in 7.74% of index admissions, increasing with frailty (p < 0.001). Readmission risk increased with frailty, 1.37 times with intermediate and 1.21 times with high-risk frailty. PCI was performed in 86.40% of low-risk, 66.03% of intermediate-risk, and 58.90% of high-risk patients (p < 0.001). Intermediate patients were 55.02% less likely and high-risk patients were 61.26% less likely to undergo PCI (p < 0.001). Length of stay means for index admissions were 2.96, 7.83, and 16.32 days for low, intermediate, and high-risk groups. Intermediate and high-risk frailty had longer length of stay, higher total cost, and were more likely to be discharged to a skilled facility (p < 0.001). CONCLUSION Among adult, all-payer inpatient visits, frailty discerned by the hospital frailty risk score was associated with increased readmissions, increased healthcare resource utilization, and lower PCI administration.
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Affiliation(s)
- Joseph Heaton
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Sohrab Singh
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Dhairya Nanavaty
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Alexis K Okoh
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Rajiv Tayal
- Division of Cardiology, The Valley Hospital, Ridgewood, New Jersey, USA
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13
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Development of a Positive Psychology Well-Being Intervention in a Community Pharmacy Setting. PHARMACY 2023; 11:pharmacy11010014. [PMID: 36649024 PMCID: PMC9844442 DOI: 10.3390/pharmacy11010014] [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: 11/17/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background: Community pharmacies are well-placed to deliver well-being interventions; however, to date, nothing has been produced specifically for this setting. The aim of this study was to develop a positive psychology intervention suitable for a community pharmacy setting with the goal of increasing the well-being of community members. Methods: Intervention development consisted of three steps: Step 1-identify the evidence-base and well-being model to underpin the basis of the intervention (Version 1); Step 2-model the intervention and gather user feedback to produce Version 2, and Step 3-revisit the evidence-base and refine the intervention to produce Version 3. Results: Findings from nine studies (seven RCTs, one cross-sectional, one N-1 design plus user feedback were applied to model a 6-week 'Prescribing Happiness (P-Hap)' intervention, underpinned by the PERMA model plus four other components from the positive psychology literature (Three Good Things, Utilising Your Signature Strengths in New Ways, Best Possible Selves and Character Strengths). A PERMA-based diary was designed to be completed 3 days a week as part of the intervention. Conclusions: This work is an important development which will direct the future implementation of interventions to support well-being in this novel setting. The next stage is to gain the perspectives of external stakeholders on the feasibility of delivering the P-Hap for its adoption into community pharmacy services in the future.
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14
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Alkeridy WA, Aljasser A, Alayed KM, Alsaad SM, Alqahtani AS, Lim CA, Alamri SH, Mekkawy DZ, Al-Sofiani M. Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia. J Multidiscip Healthc 2022; 15:1997-2005. [PMID: 36101552 PMCID: PMC9464450 DOI: 10.2147/jmdh.s379782] [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: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design Retrospective cross-sectional descriptive study. Setting and Participants A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods Only individuals fulfilling the HHC program’s eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.
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Affiliation(s)
- Walid A Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada.,General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia
| | - Arwa Aljasser
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Saad M Alsaad
- Department of Family & Community medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani S Alqahtani
- Research department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Claire Ann Lim
- Department of Medical Rehabilitation, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sultan H Alamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Saudi Geriatrics Society, Riyadh, Saudi Arabia
| | - Doaa Zainhom Mekkawy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Sofiani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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15
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Frost R, Avgerinou C, Goodman C, Clegg A, Hopkins J, Gould RL, Gardner B, Marston L, Hunter R, Manthorpe J, Cooper C, Skelton DA, Drennan VM, Logan P, Walters K. Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty (‘HomeHealth’) compared to treatment as usual: study protocol for a randomised controlled trial. BMC Geriatr 2022; 22:485. [PMID: 35659196 PMCID: PMC9166243 DOI: 10.1186/s12877-022-03160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Frailty is clinically associated with multiple adverse outcomes, including reduced quality of life and functioning, falls, hospitalisations, moves to long-term care and mortality. Health services commonly focus on the frailest, with highest levels of need. However, evidence suggests that frailty is likely to be more reversible in people who are less frail. Evidence is emerging on what interventions may help prevent or reduce frailty, such as resistance exercises and multi-component interventions, but few interventions are based on behaviour change theory. There is little evidence of cost-effectiveness.
Previously, we co-designed a new behaviour change health promotion intervention (“HomeHealth”) to support people with mild frailty. HomeHealth is delivered by trained voluntary sector support workers over six months who support older people to work on self-identified goals to maintain their independence, such as strength and balance exercises, nutrition, mood and enhancing social engagement. The service was well received in our feasibility randomised controlled trial and showed promising effects upon outcomes.
Aim
To test the clinical and cost-effectiveness of the HomeHealth intervention on maintaining independence in older people with mild frailty in comparison to treatment as usual (TAU).
Methods
Single-blind individually randomised controlled trial comparing the HomeHealth intervention to TAU. We will recruit 386 participants from general practices and the community across three English regions. Participants are included if they are community-dwelling, aged 65 + , with mild frailty according to the Clinical Frailty Scale. Participants will be randomised 1:1 to receive HomeHealth or TAU for 6 months. The primary outcome is independence in activities of daily living (modified Barthel Index) at 12 months. Secondary outcomes include instrumental activities of daily living, quality of life, frailty, wellbeing, psychological distress, loneliness, cognition, capability, falls, carer burden, service use, costs and mortality. Outcomes will be analysed using linear mixed models, controlling for baseline Barthel score and site. A health economic analysis and embedded mixed-methods process evaluation will be conducted.
Discussion
This trial will provide definitive evidence on the effectiveness and cost-effectiveness of a home-based, individualised intervention to maintain independence in older people with mild frailty in comparison to TAU, that could be implemented at scale if effective.
Trial registration
ISRCTN, ISRCTN54268283. Registered 06/04/2020.
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16
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Prevalence of Undernutrition, Frailty and Sarcopenia in Community-Dwelling People Aged 50 Years and Above: Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14081537. [PMID: 35458101 PMCID: PMC9032775 DOI: 10.3390/nu14081537] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
The world’s population aged ≥65 is expected to rise from one in eleven in 2019 to one in six by 2050. People aged ≥65 are at a risk of undernutrition, frailty, and sarcopenia. The association between these conditions is investigated in a hospital setting. However, there is little understanding about the overlap and adverse health outcomes of these conditions in community-dwelling people. This systematic review aims to quantify the reported prevalence and incidence of undernutrition, frailty, and sarcopenia among older people aged ≥50 living in community dwellings. Searches were conducted using six databases (AMED, CENTRAL, EMBASE, Web of Science, MEDLINE, and CINAHL), and 37 studies were included. Meta-analyses produced weighted combined estimates of prevalence for each condition (Metaprop, Stata V16/MP). The combined undernutrition prevalence was 17% (95% CI 0.01, 0.46, studies n = 5; participants = 4214), frailty was 13% (95% CI 0.11, 0.17 studies n = 28; participants = 95,036), and sarcopenia was 14% (95% CI 0.09, 0.20, studies n = 9; participants = 7656). Four studies reported incidence rates, of which three included data on frailty. Nearly one in five of those aged ≥50 was considered either undernourished, frail, or sarcopenic, with a higher occurrence in women, which may reflect a longer life expectancy generally observed in females. Few studies measured incidence rates. Further work is required to understand population characteristics with these conditions and the overlap between them. PROSPERO registration No. CRD42019153806.
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Meili KW, Månsdotter A, Sundberg LR, Hjelte J, Lindholm L. An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire. PLoS One 2022; 17:e0263231. [PMID: 35134053 PMCID: PMC8824323 DOI: 10.1371/journal.pone.0263231] [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: 02/08/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities. Material and methods For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities. Results The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion. Conclusion We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.
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Affiliation(s)
- Kaspar Walter Meili
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- * E-mail:
| | - Anna Månsdotter
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Living Conditions and Lifestyles, Public Health Agency Public Health Agency of Sweden, Stockholm, Sweden
| | | | - Jan Hjelte
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Haeger C, Mümken SA, O'Sullivan JL, Spang RP, Voigt-Antons JN, Stockburger M, Dräger D, Gellert P. Mobility enhancement among older adults 75 + in rural areas: Study protocol of the MOBILE randomized controlled trial. BMC Geriatr 2022; 22:65. [PMID: 35057755 PMCID: PMC8771178 DOI: 10.1186/s12877-021-02739-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Maintaining mobility in old age is crucial for healthy ageing including delaying the onset and progress of frailty. However, the extent of an individuals´ mobility relies largely on their personal, social, and environmental resources as outlined in the Life-Space Constriction Model. Recent studies mainly focus on facilitating habitual out-of-home mobility by fostering one type of resources only. The MOBILE trial aims at testing whether tablet-assisted motivational counselling enhances the mobility of community-dwelling older adults by addressing personal, social, and environmental resources. METHODS In the MOBILE randomized controlled trial, we plan to enrol 254 community-dwelling older adults aged 75 and older from Havelland, a rural area in Germany. The intervention group will receive a tablet-assisted motivational counselling at the participant´s home and two follow-up telephone sessions. Main focus of the counselling sessions lays on setting and adapting individual mobility goals and applying action planning and habit formation strategies by incorporating the personal social network and regional opportunities for engaging in mobility related activities. The control group will receive postal general health information. The primary mobility outcome is time out-of-home assessed by GPS (GPS.Rec2.0-App) at three points in time (baseline, after one month, and after three months for seven consecutive days each). Secondary outcomes are the size of the GPS-derived life-space convex hull, self-reported life-space mobility (LSA-D), physical activity (IPAQ), depressive symptoms (GDS), frailty phenotype, and health status (SF-12). DISCUSSION The MOBILE trial will test the effect of a motivational counselling intervention on out-of-home mobility in community-dwelling older adults. Novel aspects of the MOBILE trial include the preventive multi-level intervention approach in combination with easy-to-use technology. The ecological approach ensures low-threshold implementation, which increases the benefit for the people in the region. TRIAL REGISTRATION The MOBILE trial is prospectively registered at DRKS (Deutsches Register Klinischer Studien, German Registry of Clinical Trials) DRKS00025230 . Registered 5 May 2021.
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Affiliation(s)
- Christine Haeger
- Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin, Institute of Medical Sociology Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Sandra A Mümken
- Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin, Institute of Medical Sociology Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Julie L O'Sullivan
- Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin, Institute of Medical Sociology Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert P Spang
- Technische Universität Berlin, Quality Usability Lab, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Jan-Niklas Voigt-Antons
- Technische Universität Berlin, Quality Usability Lab, Straße des 17. Juni 135, 10623, Berlin, Germany
- German Research Centre for Artificial Intelligence (DFKI), Alt-Moabit 91c, 10559, Berlin, Germany
| | - Martin Stockburger
- Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin, Institute of Medical Sociology Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
- Havelland Kliniken Unternehmensgruppe, Ketziner Straße 19, 14641, Nauen, Germany
| | - Dagmar Dräger
- Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin, Institute of Medical Sociology Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Paul Gellert
- Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin, Institute of Medical Sociology Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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19
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Zhao B, Zhang X, Huang R, Yi M, Dong X, Li Z. Barriers to accessing internet-based home Care for Older Patients: a qualitative study. BMC Geriatr 2021; 21:565. [PMID: 34663218 PMCID: PMC8522081 DOI: 10.1186/s12877-021-02474-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Due to the increasingly ageing society and the shortage of nursing human resources in China, the imbalance between the home care needs of older patients and the inadequate supply of nursing services is increasing. Based on this medical situation, China is implementing internet-based home care (with the nurses who provide this care called online nurses or sharing nurses) based on the concept of the sharing economy, internet technology and knowledge from the home care experience in other countries. Internet-based home care follows an online application/offline service model. Patients place orders through an app, nurses grab orders instantly, and managers dispatch orders through a web platform based on various factors such as nurses’ qualifications, professionalism and distance from the patient. In this way, home care is provided for patients with limited mobility, such as older or disabled patients, patients in rehabilitation and terminal patients. Only by fully understanding the barriers to accessing internet-based home care can we provide quality nursing services to older patients and achieve the sustainable development of internet-based home care. Objective The goal of this study was to use qualitative methods to explore barriers to accessing internet-based home care for older patients. Methods Based on Levesque’s access to health care framework, semi-structured personal interviews were conducted with 19 older patients in a descriptive qualitative study using directed content analysis. Results We identified four barriers to accessing internet-based home care for older patients: barriers to perceiving, seeking, paying for, and engaging in internet-based home care. Specific barriers included traditional perceptions, barriers to internet use, high payment costs, uneven quality of services, and concerns about privacy and patient safety. Conclusions Internet-based home care brings new risks and challenges. In order to enable older patients to better enjoy it, it is necessary to strengthen publicity, optimize the network application process, improve the health insurance system, formulate unified nursing service standards, and address safety risks. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02474-6.
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Affiliation(s)
- Baosheng Zhao
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 324 Jingwu Weiqi Road, Jinan, Shandong Province, 250021, China
| | - Xiaoman Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, 250021, Shandong Province, China
| | - Rendong Huang
- School of Nursing, Hangzhou Medical College, No. 8 Yikang Road, Hangzhou, Zhejiang Province, 311399, China
| | - Mo Yi
- School of Nursing and Rehabilitation Shandong University, No. 44 Wenhuaxi Road, Jinan, Shandong Province, 250012, China
| | - Xiaofei Dong
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, 250021, Shandong Province, China
| | - Zhenxiang Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, 250021, Shandong Province, China.
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20
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Moon SY, Hong CH, Jeong JH, Park YK, Na HR, Song HS, Kim BC, Park KW, Park HK, Choi M, Lee SM, Chun BO, Koh SH, Park SA, Park HH, Jin JH, Lee EH, Kim SM, Han SM, Kim JS, Ha J, Choi SH. Facility-based and home-based multidomain interventions including cognitive training, exercise, diet, vascular risk management, and motivation for older adults: a randomized controlled feasibility trial. Aging (Albany NY) 2021; 13:15898-15916. [PMID: 34148030 PMCID: PMC8266338 DOI: 10.18632/aging.203213] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 12/03/2022]
Abstract
We aimed to evaluate the feasibility of multidomain intervention (MI) tailored to the Korean context. In an outcome assessor-blinded, randomized controlled trial, participants without dementia and with one or more modifiable dementia risk factors, aged 60-79 years, were randomly assigned to the facility-based MI (FMI; n=51), the home-based MI (HMI; n=51), or the control group receiving general health advice (n=50). The 24-week intervention comprised vascular risk management, cognitive training, social activity, physical exercise, nutrition guidance, and motivational enhancement. The FMI participants performed all intervention programs at a facility three times a week. The HMI participants performed some programs at a facility once every 1-2 weeks and performed others at home. The primary outcome was feasibility measured through retention, adherence, and at least no differences from the control group in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In the FMI and HMI groups, the retention rates were 88.2% and 96.1%, and adherence to the intervention was 94.5% and 96.8%, respectively. The RBANS total scale index score improved significantly in the FMI (5.46 ± 7.50, P = 0.004) and HMI (5.50 ± 8.14, P = 0.004) groups compared to the control group (-0.74 ± 11.51). The FMI and HMI are feasible and there are indicators of efficacy.
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Affiliation(s)
- So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07804, Republic of Korea
| | - Yoo Kyoung Park
- Department of Medical Nutrition, Graduate School of East-West Medical Nutrition, Kyung Hee University, Yongin 17104, Republic of Korea
| | - Hae Ri Na
- Department of Neurology, Bobath Memorial Hospital, Seongnam 13552, Republic of Korea
| | - Hong-Sun Song
- Department of Sports Sciences, Korea Institute of Sports Science, Seoul 01794, Republic of Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A University College of Medicine, Busan 49201, Republic of Korea
| | - Hee Kyung Park
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07804, Republic of Korea
| | - Muncheong Choi
- Department of Physical Education, Kookmin University, Seoul 02707, Republic of Korea
| | - Sun Min Lee
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Buong-O Chun
- Department of Sports Sciences, Korea Institute of Sports Science, Seoul 01794, Republic of Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea.,Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul 04763, Republic of Korea
| | - Sun Ah Park
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Republic of Korea.,Lab for Neurodegenerative Dementia, Department of Anatomy, Ajou University School of Medicine, Suwon 16499, Republic of Korea.,Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea
| | - Hyun-Hee Park
- Department of Neurology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Jeong-Hwa Jin
- Department of Neurology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Eun-Hye Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Sue Min Kim
- Lab for Neurodegenerative Dementia, Department of Anatomy, Ajou University School of Medicine, Suwon 16499, Republic of Korea.,Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea
| | - Song Mi Han
- Lab for Neurodegenerative Dementia, Department of Anatomy, Ajou University School of Medicine, Suwon 16499, Republic of Korea.,Neuroscience Graduate Program, Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea
| | - Jun Seok Kim
- Department of Biomedical Systems Engineering, Korea Polytechnics University, Gyeonggi 13122, Republic of Korea
| | - Jungsoon Ha
- Department of Neurology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon 22332, Republic of Korea
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21
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Kennedy MA, Hatchell KE, DiMilia PR, Kelly SM, Blunt HB, Bagley PJ, LaMantia MA, Reynolds CF, Crow RS, Maden TN, Kelly SL, Kihwele JM, Batsis JA. Community health worker interventions for older adults with complex health needs: A systematic review. J Am Geriatr Soc 2021; 69:1670-1682. [PMID: 33738803 PMCID: PMC8263299 DOI: 10.1111/jgs.17078] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/10/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.
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Affiliation(s)
- Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical
Center, VA Bedford Healthcare System, Bedford, MA
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kayla E. Hatchell
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Peter R. DiMilia
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | - Michael A. LaMantia
- Division of Geriatric Medicine, Department of Medicine,
Larner College of Medicine at The University of Vermont, Burlington, VT
| | | | - Rebecca S. Crow
- Department of Medicine, Geisel School of Medicine at
Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geriatrics and Extended Care, Veterans Affairs Medical Center, White River Junction,
White River Junction, VT
| | - Tara N. Maden
- Analytics Institute, Dartmouth-Hitchcock Clinic, Lebanon,
NH
| | | | | | - John A. Batsis
- Division of Geriatric Medicine and Gillings School of
Global Public Health, University of North Carolina, Chapel Hill, NC
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22
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. In the borderland of the body: How home-dwelling older people experience frailty. Scand J Caring Sci 2021; 36:255-264. [PMID: 33939195 DOI: 10.1111/scs.12984] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/14/2021] [Indexed: 01/10/2023]
Abstract
RATIONALE The increasing number of frail home-dwelling older people has sharpened the focus on discovering and implementing suitable treatment and care in clinical practice, aiming to prevent loss of physical functioning and preserve their autonomy and well-being. People's embodied experiences may yield rich descriptions to help to understand frailty. Thoroughly understanding older people's individual perceptions is especially relevant because the numbers of home-dwelling older people are increasing, and people tend to develop more health problems and become frailer as they age. Their perspectives are important to develop knowledge and high-quality care. AIM To explore the lived experiences of frail home-dwelling older people. METHODS We conducted a phenomenological study to obtain in-depth descriptions of the phenomenon. We interviewed 10 home-dwelling older adults (seven women and three men, 72-90 years old) in depth about their lived experience of frailty. We analysed the data using a hermeneutic phenomenological approach described by van Manen. FINDINGS The lived experience of frailty is described in one essential theme: frailty as being in the borderland of the body, including three interrelated subthemes: (1) the body shuts down; (2) living on the edge; and (3) not giving up. CONCLUSIONS Our study gives insight into lived experiences with frailty among home-dwelling older people related to their own body. Older people's experience of meaningful activities strengthened their feeling of being themselves, despite their frail and deteriorating body. Healthcare providers must consider the strategies of frail older people to consider both their vulnerabilities and self-perceived strengths. The resources and deficits of frail older people present in the state of being frail need to be recognised.
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Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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23
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Avgerinou C, Kotsani M, Gavana M, Andreou M, Papageorgiou DI, Roka V, Symintiridou D, Manolaki C, Soulis G, Smyrnakis E. Perceptions, attitudes and training needs of primary healthcare professionals in identifying and managing frailty: a qualitative study. Eur Geriatr Med 2021; 12:321-332. [PMID: 33125682 PMCID: PMC7990835 DOI: 10.1007/s41999-020-00420-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/14/2020] [Indexed: 10/28/2022]
Abstract
PURPOSE Although frailty can be delayed or prevented by appropriate interventions, these are often not available in countries lacking formal education and infrastructure in geriatrics. The aim of this study was to: (a) explore ideas, perceptions and attitudes of primary health care (PHC) professionals towards frailty in a country where geriatrics is not recognised as a specialty; (b) explore PHC professionals' training needs in frailty; and (c) define components of a frailty educational programme in PHC. METHODS Qualitative design, using two focus groups with PHC professionals conducted in Thessaloniki, Greece. Focus groups were audio recorded and transcribed. Data were analysed with thematic analysis. RESULTS In total 31 PHC professionals (mean age: 46 years; gender distribution: 27 females, 4 males) participated in the study (physicians n = 17; nurses n = 12; health visitors n = 2). Four main themes were identified: (1) Perceptions and understanding of frailty; (2) Facilitators and barriers to frailty identification and management; (3) Motivation to participate in a frailty training programme; (4) Education and training. The main barriers for the identification and management of frailty were associated with the healthcare system, including duration of appointments, a focus on prescribing, and problems with staffing of allied health professionals, but also a lack of education. Training opportunities were scarce and entirely based on personal incentive. Professionals were receptive to training either face-to-face or online. A focus on learning practical skills was key. CONCLUSION Education and training of professionals and interdisciplinary collaboration are essential and much needed for the delivery of person-centred care for people with frailty living in the community.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
| | - Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", 54000, Nancy, France
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitra-Iosifina Papageorgiou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Violeta Roka
- Farkadona Health Center, Farkadona, Trikala, Greece
| | | | | | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
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24
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Jayanama K, Theou O, Godin J, Cahill L, Shivappa N, Hébert JR, Wirth MD, Park YM, Fung TT, Rockwood K. Relationship between diet quality scores and the risk of frailty and mortality in adults across a wide age spectrum. BMC Med 2021; 19:64. [PMID: 33722232 PMCID: PMC7962372 DOI: 10.1186/s12916-021-01918-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Beyond intakes of total energy and individual nutrient, eating patterns may influence health, and thereby the risk of adverse outcomes. How different diet measures relate to frailty-a general measure of increased vulnerability to unfavorable health outcomes-and mortality risk, and how this might vary across the life course, is not known. We investigated the associations of five dietary indices (Nutrition Index (NI), the energy-density Dietary Inflammatory Index (E-DII™), Healthy Eating Index-2015 (HEI-2015), Mediterranean Diet Score (MDS), and Dietary Approaches to Stop Hypertension (DASH)) with frailty and mortality. METHODS We included 15,249 participants aged ≥ 20 years from the 2007-2012 cohorts of the National Health and Nutrition Examination Survey (NHANES). The NI combined 31 nutrition-related deficits. The E-DII is a literature-derived dietary index associated with inflammation. The HEI-2015 assesses adherence to the Dietary Guidelines of Americans. The MDS represents adherence to the traditional Mediterranean diet. DASH combines macronutrients and micronutrients to prevent hypertension. Frailty was evaluated using a 36-item frailty index. Mortality status was ascertained up to December 31, 2015. RESULTS Participants' mean age was 47.2 ± 16.7 years and 51.7% were women. After adjusting for age, sex, race, educational level, marital and employment status, smoking, BMI, and study cohort, higher NI and E-DII scores and lower HEI-2015, MDS, and DASH scores were individually significantly associated with frailty. All dietary scores were significantly associated with 8-year mortality risk after adjusting for basic covariates and frailty: NI (hazard ratio per 0.1 point, 1.15, 95%CI 1.10-1.21), E-DII (per 1 point, 1.05, 1.01-1.08), HEI-2015 (per 10 points, 0.93, 0.89-0.97), MDS (per 1 point, 0.94, 0.90-0.97), and DASH (per 1 point, 0.96, 0.93-0.99). The associations of E-DII, HEI-2015, and MDS scores with 8-year mortality risk persisted after additionally adjusting for NI. CONCLUSIONS NI, E-DII, HEI-2015, MDS, and DASH scores are associated with frailty and 8-year mortality risk in adults across all ages. Nevertheless, their mechanisms and sensitivity to predict health outcomes may differ. Nutrition scores have the potential to include measures of both consumption and laboratory and physical measures of exposure.
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Affiliation(s)
- Kulapong Jayanama
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
| | - Olga Theou
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Judith Godin
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
| | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC USA
| | - James R. Hébert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC USA
| | - Michael D. Wirth
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC USA
- College of Nursing, University of South Carolina, Columbia, SC USA
| | - Yong-Moon Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Teresa T. Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Nutrition, Simmons University, Boston, MA USA
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
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25
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Galekop MMJ, Uyl-de Groot CA, Ken Redekop W. A Systematic Review of Cost-Effectiveness Studies of Interventions With a Personalized Nutrition Component in Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:325-335. [PMID: 33641765 DOI: 10.1016/j.jval.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Important links between dietary patterns and diseases have been widely applied to establish nutrition interventions. However, knowledge about between-person heterogeneity regarding the benefits of nutrition intervention can be used to personalize the intervention and thereby improve health outcomes and efficiency. We performed a systematic review of cost-effectiveness analyses (CEAs) of interventions with a personalized nutrition (PN) component to assess their methodology and findings. METHODS A systematic search (March 2019) was performed in 5 databases: EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. CEAs involving interventions in adults with a PN component were included; CEAs focusing on clinical nutrition or undernutrition were excluded. The CHEERS checklist was used to assess the quality of CEAs. RESULTS We identified 49 eligible studies among 1792 unique records. Substantial variation in methodology was found. Most studies (91%) focused only on psychological concepts of PN such as behavior and preferences. Thirty-four CEAs were trial-based, 13 were modeling studies, and 4 studies were both trial- and model-based. Thirty-two studies used quality-adjusted life year as an outcome measure. Different time horizons, comparators, and modeling assumptions were applied, leading to differences in costs/quality-adjusted life years. Twenty-eight CEAs (49%) concluded that the intervention was cost-effective, and 75% of the incremental cost-utility ratios were cost-effective given a willingness-to-pay threshold of $50 000 per quality-adjusted life year. CONCLUSIONS Interventions with PN components are often evaluated using various types of models. However, most PN interventions have been considered cost-effective. More studies should examine the cost-effectiveness of PN interventions that combine psychological and biological concepts of personalization.
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Affiliation(s)
- Milanne M J Galekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - W Ken Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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26
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Muszalik M, Kotarba A, Borowiak E, Puto G, Cybulski M, Kȩdziora-Kornatowska K. Socio-Demographic, Clinical and Psychological Profile of Frailty Patients Living in the Home Environment and Nursing Homes: A Cross-Sectional Study. Front Psychiatry 2021; 12:736804. [PMID: 34950064 PMCID: PMC8689074 DOI: 10.3389/fpsyt.2021.736804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Frailty syndrome, as a physiological syndrome, is characterized by a gradual decline in physiological reserve and a lowered resistance to stress-inducing factors, leading to an increased risk of adverse outcomes. It is significantly connected with dependence on care and frequent hospitalizations. Objectives: The aim of the study was to describe socio-demographic, clinical and psychological profile of frailty older adults living in their own homes and to nursing homes. Methods: The study was conducted with 180 patients who were over 60 years of age, the mean (±SD) was 74.1 (±8.8) years. Among the subjects, 90 individuals were community-dwelling older adults. The survey used a list of socio-demographic questions, as well as the following scales: Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), SHARE-FI, and The World Health Organization Quality of Life (WHOQOL-Bref). Results: Pre-frailty was confirmed in 49 (27.2%) patients, and frailty syndrome was noticed in 47 patients (26.1%). The prevalence of frailty syndrome in the study group was related to: place of living (p < 0.001), age (p < 0.001), widowhood (p < 0.001), a poor economic situation (p < 0.001), basic education level (p < 0.001), living alone (p < 0.001), longer duration of illness (p < 0.001), comorbidities (p < 0.001), more medications taken (p < 0.001), deterioration of hearing (p = 0.003), impairment of cognitive functions (p < 0.001), depression (p < 0.001), and decreased quality of life (p < 0.001). Discussion: A lot of socio-demographic and medical factors, particularly cognitive and mental functioning were connected with the prevalence and progression of frailty syndrome in the study group. Quality of life was significantly dependent on the presence of frailty syndrome, both in homes and in nursing homes.
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Affiliation(s)
- Marta Muszalik
- Department of Geriatrics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Agnieszka Kotarba
- Department of Nursing Pedagogics, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
| | - Ewa Borowiak
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
| | - Grażyna Puto
- Department of Internal and Environmental Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| | - Kornelia Kȩdziora-Kornatowska
- Department of Geriatrics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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27
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Adja KYC, Lenzi J, Sezgin D, O'Caoimh R, Morini M, Damiani G, Buja A, Fantini MP. The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective. Front Public Health 2020; 8:599170. [PMID: 33282818 PMCID: PMC7689262 DOI: 10.3389/fpubh.2020.599170] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Across the world, life expectancy is increasing. However, the years of life gained do not always correspond to healthy life years, potentially leading to an increase in frailty. Given the extent of population aging, the association between frailty and age and the impact of frailty on adverse outcomes for older people, frailty is increasingly being recognized to be a significant public health concern. Early identification of the condition is important to help older adults regain function and to prevent the negative outcomes associated with the syndrome. Despite the importance of diagnosing frailty, there is no definitive evidence or consensus of whether screening should be routinely implemented. A broad range of screening and assessment instruments have been developed taking a biopsychosocial approach, characterizing frailty as a dynamic state resulting from deficits in any of the physical, psychological and social domains, which contribute to health. All these aspects of frailty should be identified and addressed using an integrated and holistic approach to care. To achieve this goal, public health and primary health care (PHC) need to become the fulcrum through which care is offered, not only to older people and those that are frail, but to all individuals, favoring a life-course and patient-centered approach centered around integrated, community-based care. Public health personnel should be trained to address frailty not merely from a clinical perspective, but also in a societal context. Interventions should be delivered in the individuals' environment and within their social networks. Furthermore, public health professionals should contribute to education and training on frailty at a community level, fostering community-based interventions to support older adults and their caregivers to prevent and manage frailty. The purpose of this paper is to offer an overview of the concept of frailty for a public health audience in order to raise awareness of the multidimensional aspects of frailty and on how these should be addressed using an integrated and holistic approach to care.
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Affiliation(s)
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Rónán O'Caoimh
- Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Mara Morini
- Italian Scientific Society of Hygiene and Preventive Medicine - Primary Care Group, Bologna, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Buja
- Laboratory of Health Care Services and Health Promotion, Evaluation Unit of Hygiene and Public Health Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Long-term effects of the Montreal museum of fine arts participatory activities on frailty in older community dwellers: results of the A-Health study. Eur Geriatr Med 2020; 12:295-302. [PMID: 33051855 DOI: 10.1007/s41999-020-00408-w] [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: 07/13/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The study aims (1) to examine the long-term effects (i.e., at 12 months) of the Montreal museum of fine arts (MMFA) participatory art-based activities on frailty in a subset of participants of the Art and Health (A-Health) study and (2) to compare these long-term effects with short-term effects (i.e., at 3 months). METHODS The A-Health study is a pre-post intervention, single arm, prospective and longitudinal study. A subset of 101 participants (67.3%) who completed the 12-month follow-up assessment was selected for this study. The intervention consisted in one weekly structured participatory art-based workshop over a 3-month period. Participants were separated according to their frailty status: vigorous (i.e., no frailty) versus mild frailty, moderate frailty and frailty merging mild and moderate frailty. Frailty was assessed before the intervention (M0), at the end of the 3-month intervention (M3) and 12 months (M15) after the end of the intervention. RESULTS The mean value of frailty score was lower after the intervention compared to the beginning, regardless of the time of the assessments (i.e., M3 and M15). The proportion of vigorous participants increased and the proportion of mild frail participants decreased at the end of the intervention (i.e., M3) but no long-term effect was shown (i.e., M15) compared to M0. The proportion of moderate frail participants and frail participants at M15 were significantly lower compared to M0. CONCLUSION The MMFA participatory art-based activities improved frailty at short and long terms, suggesting that it could be an effective way to promote an active and healthy aging. TRIAL REGISTRATION NCT03557723; Title: Effect of Art Museum Activity Program for the Elderly on Health: A Pilot Study; First submission date: January 31, 2018; First posted date: June 15, 2018; prospectively registered.
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Feasibility of a 12 Week Physical Intervention to Prevent Cognitive Decline and Disability in the At-Risk Elderly Population in Korea. J Clin Med 2020; 9:jcm9103135. [PMID: 32998321 PMCID: PMC7600858 DOI: 10.3390/jcm9103135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022] Open
Abstract
There is a need for measures that can prevent the onset of dementia in the rapidly aging population. Reportedly, sustained physical exercise can prevent cognitive decline and disability. This study aimed to assess the feasibility of a 12-week physical exercise intervention (PEI) for delay of cognitive decline and disability in the at-risk elderly population in Korea. Twenty-six participants (aged 67.9 ± 3.6 years, 84.6% female) at risk of dementia were assigned to facility-based PEI (n = 15) or home-based PEI (n = 11). The PEI program consisted of muscle strength training, aerobic exercise, balance, and stretching using portable aids. Feasibility was assessed by retention and adherence rates. Physical fitness/cognitive function were compared before and after the PEI. Retention and adherence rates were 86.7% and 88.3%, respectively, for facility-based PEI and 81.8% and 62.3% for home-based PEI. No intervention-related adverse events were reported. Leg strength/endurance and cardiopulmonary endurance were improved in both groups: 30 s sit-to-stand test (facility-based, p = 0.002; home-based, p = 0.002) and 2 -min stationary march (facility-based, p = 0.001; home-based, p = 0.022). Cognitive function was improved only after facility-based PEI (Alzheimer’s Disease Assessment Scale-cognitive total score, p = 0.009; story memory test on Literacy Independent Cognitive Assessment, p = 0.026). We found that, whereas our PEI is feasible, the home-based program needs supplementation to improve adherence.
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Cooper C, Aguirre E, Barber JA, Bass N, Brodaty H, Burton A, Higgs P, Hunter R, Huntley J, Lang I, Kales HC, Marchant NL, Minihane AM, Ritchie K, Morgan-Trimmer S, Walker Z, Walters K, Wenborn J, Rapaport P. APPLE-Tree (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline) programme: Protocol. Int J Geriatr Psychiatry 2020; 35:811-819. [PMID: 31833588 DOI: 10.1002/gps.5249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/07/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Observational studies indicate that approximately a third of dementia cases are attributable to modifiable cardiometabolic, physical and mental health, and social and lifestyle risk factors. There is evidence that intensive behaviour change interventions targeting these factors can reduce cognitive decline. [Figure: see text] METHODS AND ANALYSIS: We will design and test a low intensity, secondary dementia-prevention programme (Active Prevention in People at risk of dementia: Lifestyle, bEhaviour change and Technology to REducE cognitive and functional decline, "APPLE-Tree") to slow cognitive decline in people with subjective cognitive decline with or without objective cognitive impairment. We will embed our work within social science research to understand how dementia prevention is currently delivered and structured. We will carry out systematic reviews and around 50 qualitative interviews with stakeholders, using findings to coproduce the APPLE-Tree intervention. We plan a 10-session group intervention, involving personalised goal-setting, with individual sessions for those unable or unwilling to attend groups, delivered by psychology assistants who will be trained and supervised by clinical psychologists. The coproduction group (including public and patient involvement [PPI], academic and clinical/third-sector professional representatives) will use the Behaviour Change Wheel theoretical framework to develop it. We will recruit and randomly allocate 704 participants, 1:1 to the intervention: informational control group. This sample size is sufficient to detect a between-group difference at 2 years of 0.15 on the primary outcome (cognition: modified neuropsychological test battery; 90% power, 5% significance, effect size 0.25, SD 0.6). DISSEMINATION We will work with Public Health England and third-sector partners to produce an effective national implementation approach, so that if our intervention works, it is used in practice.
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Affiliation(s)
- Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | - Elisa Aguirre
- Division of Psychiatry, University College London, London, UK
| | - Julie A Barber
- Division of Psychiatry, University College London, London, UK
| | - Nick Bass
- Division of Psychiatry, University College London, London, UK
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Paul Higgs
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- Division of Psychiatry, University College London, London, UK
| | | | - Iain Lang
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, University California Davis, Davis, California
| | | | | | | | | | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK
| | - Kate Walters
- Division of Psychiatry, University College London, London, UK
| | | | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
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Won CW. Diagnosis and Management of Frailty in Primary Health Care. Korean J Fam Med 2020; 41:207-213. [PMID: 32713174 PMCID: PMC7385295 DOI: 10.4082/kjfm.20.0122] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 12/22/2022] Open
Abstract
Disability in older adults has become a significant burden, both individually and socially, due to the rapidly aging population in Korea. It is important to manage both frailty and chronic diseases to delay disability. Frailty, which is considered to be a transition phase between healthy status and disability, is defined as a significant decline in functional reserves of multiple organ systems and the resultant extreme vulnerability to stressors, leading to a higher risk of adverse health-related outcomes. The frailty phenotype and frailty index are the most commonly used methods to diagnose frailty. Frailty is related to physical, psychological, cognitive, and social dysfunction, and is sometimes caused by chronic disease. Therefore, primary care providers are ideally situated to incorporate the concept of frailty into their practice, as they are champions in comprehensive care. Although the identification and treatment of frailty is not yet standard practice in primary care, primary care physicians must use the electronic frailty index to identify frailty in all the patients aged ≥65 years in the United Kingdom. In Canada, some insurance companies and governments are using a similar program, which is called the Community Actions and Resources Empowering Seniors model. The clinical practice guidelines of the International Conference of Frailty and Sarcopenia Research, as well as some additional references, will be introduced. Here, we review the current literature on how to diagnose and manage frailty in primary care.
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Affiliation(s)
- Chang Won Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Sezgin D, Liew A, O'Donovan MR, O'Caoimh R. Pre-frailty as a multi-dimensional construct: A systematic review of definitions in the scientific literature. Geriatr Nurs 2020; 41:139-146. [DOI: 10.1016/j.gerinurse.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
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Lawless MT, Archibald MM, Ambagtsheer RC, Kitson AL. Factors influencing communication about frailty in primary care: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:436-450. [PMID: 31551158 DOI: 10.1016/j.pec.2019.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/14/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To summarise the available evidence on the factors influencing communication about frailty in the primary care setting. METHODS We conducted a scoping review, searching five electronic databases (PubMed, Scopus, CINAHL, PsycINFO, and ProQuest) for studies addressing communication about frailty in primary care practice. Reference list and grey literature searching was conducted to identify additional articles. A narrative descriptive method was used to synthesise the findings. RESULTS The search identified 3185 articles and 37 were included in the review. We identified five categories of factors influencing communication about frailty at the consumer, healthcare provider, and system levels: (1) consumer perceptions, information needs, and communication preferences; (2) healthcare providers' knowledge, capacities, and attitudes; (3) clinical communication skills and training; (4) availability of information and communication technologies; and (5) care coordination, collaboration, and case management. CONCLUSION Findings offer considerations for the design and delivery of initiatives to improve communication about frailty in primary care both at the local clinical level and at the broader level of healthcare service delivery. PRACTICE IMPLICATIONS Healthcare providers and systems require practical, evidence-informed guidance regarding the development of a systematic approach to the quality and timing of communication about frailty in healthcare encounters.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.
| | - Mandy M Archibald
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
| | | | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia
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Park HK, Jeong JH, Moon SY, Park YK, Hong CH, Na HR, Song HS, Lee SM, Choi M, Park KW, Kim BC, Cho SH, Chun BO, Choi SH. South Korean Study to Prevent Cognitive Impairment and Protect Brain Health Through Lifestyle Intervention in At-Risk Elderly People: Protocol of a Multicenter, Randomized Controlled Feasibility Trial. J Clin Neurol 2020; 16:292-303. [PMID: 32319247 PMCID: PMC7174118 DOI: 10.3988/jcn.2020.16.2.292] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The prevalence of dementia is increasing in South Korea. Multidomain interventions may be useful for preventing dementia. Such programs need to be disseminated to elderly Koreans throughout the country. We have developed programs of the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN), which consists of a facility-based multidomain intervention (FMI) program and a home-based multidomain intervention (HMI) program suitable for elderly Koreans. We aim to determine the feasibility of the SUPERBRAIN programs before a large-scale randomized controlled trial. METHODS We will recruit 150 participants among those without dementia aged 60-79 years with at least 1 modifiable dementia risk factor. They will be randomly assigned in a 1:1:1 ratio to the FMI, HMI, and the waiting-list control arm. The 6-month multidomain intervention consists of management of metabolic and vascular risk factors, cognitive training and social activity, physical exercise, nutritional guidance, and motivational enhancement programs. The primary outcomes are adherence and retention rates and changes in the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status from baseline to the study end. The main secondary outcomes are disability, depressive symptoms, quality of life, vascular risk factors, physical performance, nutritional assessment, and motivation questionnaire. There will be an exploratory evaluation of neurotrophic, neurodegeneration, and neuroinflammation factors, microbiome, telomere length, electroencephalography, and neuroimaging measures. CONCLUSIONS The results obtained will provide information on the applicability of these multidomain intervention programs to at-risk elderly people.
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Affiliation(s)
- Hee Kyung Park
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Kyoung Park
- Department of Medical Nutrition, Graduate School of East-West Medical Nutrition, Kyung Hee University, Suwon, Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Hae Ri Na
- Department of Neurology, Bobath Memorial Hospital, Seongnam, Korea
| | - Hong Sun Song
- Department of Sports Sciences, Korea Institute of Sports Science, Seoul, Korea
| | - Sun Min Lee
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Muncheong Choi
- Department of Physical Education, Kookmin University, Seoul, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Buong O Chun
- Department of Sports Sciences, Korea Institute of Sports Science, Seoul, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea.
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McGarrigle L, Squires E, Wallace LMK, Godin J, Gorman M, Rockwood K, Theou O. Investigating the feasibility and reliability of the Pictorial Fit-Frail Scale. Age Ageing 2019; 48:832-837. [PMID: 31579907 DOI: 10.1093/ageing/afz111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/20/2019] [Accepted: 06/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND the Pictorial Fit-Frail Scale (PFFS) was designed as a simple and practical approach to the identification of frailty. OBJECTIVES To investigate the feasibility and reliability of this visual image-based tool, when used by patients, caregivers and healthcare professionals (HCPs) in clinical settings. DESIGN observational study. SETTING three outpatient geriatric healthcare settings. SUBJECTS patients (n = 132), caregivers (n = 84), clinic nurses (n = 7) and physicians (n = 10). METHODS the PFFS was administered to all patients. Where available, HCPs and caregivers completed the scale based on the patients' health. In the geriatric day hospital, the PFFS was completed on admission and administered again within 7-14 days. Time and level of assistance needed to complete the scale were recorded. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were used to assess test-retest and inter-rater reliability. RESULTS mean time to complete the scale (minutes:seconds ± SD) was 4:30 ± 1:54 for patients, 3:13 ± 1:34 for caregivers, 1:28 ± 0:57 for nurses and 1:32 ± 1:40 for physicians. Most patients were able to complete the scale unassisted (64%). Mean patient PFFS score was 11.1 ± 5.3, mean caregiver score was 13.2 ± 6.3, mean nurse score was 10.7 ± 4.5 and mean physician score was 11.1 ± 5.6; caregiver scores were significantly higher than patient (P < 0.01), nurse (P < 0.001) and physician (P < 0.01) scores. Test-retest reliability was good for patients (ICC = 0.78, [95%CI = 0.67-0.86]) and nurses (ICC = 0.88 [0.80-0.93]). Inter-rater reliability between HCPs was also good (ICC = 0.75 [0.63-0.83]). CONCLUSION the PFFS is a feasible and reliable tool for use with patients, caregivers and HCPs in clinical settings. Further research on the validity and responsiveness of the tool is necessary.
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Affiliation(s)
- Lisa McGarrigle
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Emma Squires
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
| | - Lindsay M K Wallace
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Mary Gorman
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- St. Martha’s Regional Hospital, Antigonish, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
| | - Olga Theou
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax B3H 2E1, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax B3H 2E1, Nova Scotia, Canada
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Avgerinou C, Gardner B, Kharicha K, Frost R, Liljas A, Elaswarapu R, Manthorpe J, Drennan VM, Goodman C, Iliffe S, Walters K. Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1333-1343. [PMID: 31148312 PMCID: PMC6771617 DOI: 10.1111/hsc.12781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/22/2019] [Accepted: 04/26/2019] [Indexed: 06/02/2023]
Abstract
Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi-structured interviews with 16 older people with mild frailty who received a pilot home-based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio-recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most participants, though the process of goal setting needed time and consideration. Goals on maintaining independence, monitoring of progress and receiving feedback were reported to increase motivation. Physical/mental capability and knowledge/perception of own needs were main determinants of the type of goals chosen by participants as well as the approach used by the project workers. Older people with complex needs benefited from care coordination, with a combination of goal setting and elements of social, practical and emotional support in varying proportions. Mildly frail older people responded well to a behaviour change approach to promote health and well-being. Further consideration is needed of the most effective strategies based on complexity of needs, and how to overcome barriers among people with cognitive impairment.
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Affiliation(s)
- Christina Avgerinou
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | | | - Kalpa Kharicha
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Rachael Frost
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Ann Liljas
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Rekha Elaswarapu
- Age UK Ealing (Patient and Public Involvement and Engagement representative)LondonUK
| | - Jill Manthorpe
- Social Care Workforce Research UnitKing’s College LondonLondonUK
| | - Vari M. Drennan
- Centre for Health and Social Care ResearchKingston University and St George’s, University of LondonLondonUK
| | - Claire Goodman
- Centre for Research in Primary and Community CareUniversity of HertfordshireHatfieldUK
| | - Steve Iliffe
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Kate Walters
- Department of Primary Care and Population HealthUniversity College LondonLondonUK
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Aspell N, O'Sullivan M, O'Shea E, Irving K, Duffy C, Gorman R, Warters A. Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland. Int J Geriatr Psychiatry 2019; 34:999-1007. [PMID: 30901483 PMCID: PMC6619240 DOI: 10.1002/gps.5101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 03/17/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify factors that predict admission to long-term care (LTC) and mortality among community-based, dependent older people in Ireland, who were in receipt of formal home support. METHODS An audit was conducted of all community-dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals. RESULTS The audit comprised 1597 community-dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8% and 9%, respectively, during the 12-month period. Factors significantly associated with admission to LTC were "cognitive dysfunction" [OR 2.10 (1.41-3.14), P < .001] and the intensity of home support [OR 1.05 (1.01-1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001). CONCLUSION "Cognitive dysfunction" and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive-specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer.
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Affiliation(s)
- Niamh Aspell
- North Dublin Homecare Ltd.DublinIreland,Services for Older People, Health Service ExecutiveCommunity Healthcare Organisation, Ballymun Healthcare FacilityDublinIreland
| | - Maria O'Sullivan
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Eamon O'Shea
- Centre for Economic and Social Research on DementiaNational University of IrelandGalwayIreland
| | - Kate Irving
- School of Nursing and Human SciencesDublin City UniversityDublinIreland
| | - Chloe Duffy
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Rebecca Gorman
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Austin Warters
- Services for Older People, Health Service ExecutiveCommunity Healthcare Organisation, Ballymun Healthcare FacilityDublinIreland
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Proud L, McLoughlin C, Kinghorn P. ICECAP-O, the current state of play: a systematic review of studies reporting the psychometric properties and use of the instrument over the decade since its publication. Qual Life Res 2019; 28:1429-1439. [PMID: 30666550 PMCID: PMC6522451 DOI: 10.1007/s11136-019-02114-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE A paper reporting the development of the ICECAP-O was published in 2006. Since then, there has been increasing interest in the use of capability-based measures within health economics and the ICECAP-O has been suggested for use in economic evaluation by decision-making bodies in the Netherlands and UK. METHODS A systematic review of studies published between January 2006 and October 2018 which have assessed the psychometric properties of ICECAP-O or utilised the measure within economic evaluation. RESULTS Twenty-four studies explored the psychometric properties of ICECAP-O and 21 have utilised the measure within economic evaluation; one study reported psychometric properties as well as utilising the measure within economic evaluation. The ICECAP-O has good construct validity and responsiveness, but there is evidence of some issues relating to content validity. In the context of economic evaluation, the ICECAP-O has, to date, mainly been included as a secondary economic measure and the reporting of results is brief with minimal detail and often no discussion. Five of the economic evaluation studies combined scores from ICECAP-O with time, but each used different terminology to describe this result. CONCLUSION Focus, in terms of publications, appears to have shifted now from assessment of psychometric properties to the utilisation of the ICECAP-O within economic evaluation. Further research is needed with respect to a decision-rule for the ICECAP measures. This additional research should also guide users in terms of appropriate analysis, terminology and presentation of results, which are in-keeping with the conceptual framework underpinning the ICECAP-O.
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Affiliation(s)
- Louise Proud
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, UK
| | - Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, UK
| | - Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, UK.
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Kojima G, Liljas AEM, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk Manag Healthc Policy 2019; 12:23-30. [PMID: 30858741 PMCID: PMC6385767 DOI: 10.2147/rmhp.s168750] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Older adults are a highly heterogeneous group with variable health and functional life courses. Frailty has received increasing scientific attention as a potential explanation of the health diversity of older adults. The frailty phenotype and the Frailty Index are the most frequently used frailty definitions, but recently new frailty definitions that are more practical have been advocated. Prevalence of frailty among the community-dwelling population aged 65 years and older is ~10% but varies depending on which frailty definitions are used. The mean prevalence of frailty gradually increases with age, but the individual's frailty level can be improved. Older adults, especially frail older adults, form the main users of medical and social care services. However, current health care systems are not well prepared to deal with the chronic and complex medical needs of frail older patients. In this context, frailty is potentially a perfect fit as a risk stratification paradigm. The evidence from frailty studies has not yet been fully translated into clinical practice and health care policy making. Successful implementation would improve quality of care and promote healthy aging as well as diminish the impact of aging on health care systems and strengthen their sustainability. At present, however, there is no effective treatment for frailty and the most effective intervention is not yet known. Based on currently available evidence, multi-domain intervention trials, including exercise component, especially multicomponent exercise, which includes resistance training, seem to be promising. The current challenges in frailty research include the lack of an international standard definition of frailty, further understanding of interventions to reverse frailty, the best timing for intervention, and education/training of health care professionals. The hazards of stigmatization should also be considered. If these concerns are properly addressed, widespread application of public health approaches will be possible, including screening, identification, and treatment of frailty, resulting in better care and healthier aging for older people.
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Affiliation(s)
- Gotaro Kojima
- Department of Primary Care and Population Health, University College London, London, UK,
| | - Ann E M Liljas
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK,
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Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23:771-787. [PMID: 31641726 PMCID: PMC6800406 DOI: 10.1007/s12603-019-1273-z] [Citation(s) in RCA: 446] [Impact Index Per Article: 89.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. METHODS These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.
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Affiliation(s)
- E Dent
- E. Dent, Torrens University Australia, Adelaide, Australia,
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Jayanama K, Theou O, Blodgett JM, Cahill L, Rockwood K. Frailty, nutrition-related parameters, and mortality across the adult age spectrum. BMC Med 2018; 16:188. [PMID: 30360759 PMCID: PMC6202862 DOI: 10.1186/s12916-018-1176-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nutritional status and individual nutrients have been associated with frailty in older adults. The extent to which these associations hold in younger people, by type of malnutrition or grades of frailty, is unclear. Our objectives were to (1) evaluate the relationship between individual nutrition-related parameters and frailty, (2) investigate the association between individual nutrition-related parameters and mortality across frailty levels, and (3) examine whether combining nutrition-related parameters in an index predicts mortality risk across frailty levels. METHODS This observational study assembled 9030 participants aged ≥ 20 years from the 2003-2006 cohorts of the National Health and Nutrition Examination Survey who had complete frailty data. A 36-item frailty index (FI) was constructed excluding items related to nutritional status. We examined 62 nutrition-related parameters with established cut points: 34 nutrient intake items, 5 anthropometric measurements, and 23 relevant blood tests. The 41 nutrition-related parameters which were associated with frailty were combined into a nutrition index (NI). All-cause mortality data until 2011 were identified from death certificates. RESULTS All 5 anthropometric measurements, 21/23 blood tests, and 19/34 nutrient intake items were significantly related to frailty. Although most nutrition-related parameters were directly related to frailty, high alcohol consumption and high levels of serum alpha-carotene, beta-carotene, beta-cryptoxanthin, total cholesterol, and LDL-c were associated with lower frailty scores. Only low vitamin D was associated with increased mortality risk across all frailty levels. Seventeen nutrition-related parameters were associated with mortality in the 0.1-0.2 FI group, 11 in the 0.2-0.3 group, and 16 in the > 0.3 group. Overall, 393 (5.8%) of the participants had an NI score less than 0.1 (abnormality in ≤ 4 of the 41 parameters examined). Higher levels of NI were associated with higher mortality risk after adjusting for frailty and other covariates (HR per 0.1: 1.19 [95%CI 1.133-1.257]). CONCLUSIONS Most nutrition-related parameters were correlated to frailty, but only low vitamin D was associated with higher risk for mortality across levels of frailty. As has been observed with other age-related phenomena, even though many nutrition-related parameters were not significantly associated with mortality individually, when combined in an index, they strongly predicted mortality risk.
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Affiliation(s)
- Kulapong Jayanama
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Health Care of the Elderly, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kenneth Rockwood
- Centre for Health Care of the Elderly, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. .,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Bldg., 5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E1, Canada.
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Thiel C, Braun T, Grüneberg C. [Physical training as core component of multimodal treatment of older frail people-study protocol of a randomized controlled pilot study]. Z Gerontol Geriatr 2018; 52:45-60. [PMID: 30206744 DOI: 10.1007/s00391-018-1443-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical practice guidelines recommend a multimodal intervention based on standardized screening for the treatment of frailty, which includes physical exercise as the main component. This study protocol describes a planned randomized controlled pilot study to evaluate the feasibility of a main study and first assessment of the effects of a multimodal, resource-oriented intervention program on frailty in older people. METHODS AND ANALYSES A total of 50 community-dwelling older men and women with frailty, ≥65 years of age, will be randomly allocated to the intervention or control group. The intervention group receives usual care and a multimodal intervention program. This program consists of a multidimensional screening, verbal counselling, written instructions on individual functional and health status, a home-based physical exercise program (high-intensity functional exercise program, HIFE), and support related to cognition, mood, risk of falling, medication, nutrition and self-care as required. The control group participants will receive usual care only. The feasibility will be assessed by indicators for processes, resources and management (practicability), as well as for acceptance, safety and possible effects of the intervention. The frailty index and secondary clinical endpoints will be assessed before and after the 3‑month intervention, as well as after a 3-month follow-up to estimate the effects. Data will be analyzed according to the intention-to-treat principle. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of the German Physiotherapy Association (ref. number: 2017-02). Outcomes will be disseminated in a peer-reviewed journal and at specialist conferences. TRIAL REGISTRATION NUMBER German Clinical Trial Register: DRKS00011831.
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Affiliation(s)
- Christian Thiel
- Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Deutschland.
| | - Tobias Braun
- Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Deutschland
| | - Christian Grüneberg
- Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Deutschland
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Huter K, Dubas-Jakóbczyk K, Kocot E, Kissimova-Skarbek K, Rothgang H. Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:14. [PMID: 29686540 PMCID: PMC5902889 DOI: 10.1186/s12962-018-0100-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. METHODS Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. RESULTS Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. CONCLUSION There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.
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Affiliation(s)
- Kai Huter
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Katarzyna Dubas-Jakóbczyk
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Kissimova-Skarbek
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Heinz Rothgang
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
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