Interventions to prevent and treat frailty in community-dwelling older adults: a scoping review of the literature and international policies

This study aimed to find out what information was available in regards to helping to prevent or reduce frailty. This was done by use of a scoping review, where peer-reviewed journal articles were systematically searched to find ways other researchers used to prevent or reduce the level of frailty.

Research Results

Findings: Our review identified 14 studies that focused on reducing the level of frailty in community-dwelling older adults. The type of interventions studied included: physical activity interventions; physical activity combined with nutritional interventions; home modifications and/or exercise; the use of a comprehensive assessment of health and well-being and active follow-up for the health issues identified; a comprehensive assessment of health and well-being combined with home visits; and a combination of physical activity, nutrition and memory training.

The interventions that significantly reduced the number of frailty markers/level of frailty included the physical activity interventions (all types and combinations), and the prehab study. The home modification study had a non-significant effect and the comprehensive geriatric assessment studies had mixed findings. All interventions of physical activity alone and physical activity combined with nutrition and/or memory training significantly reduced the level of frailty. The comprehensive assessment interventions had mixed findings. None of the studies involved the caregiver in the intervention, and several studies excluded participants with cognitive impairment.

Impact of findings: Physical activity combined with nutrition and/or memory training seemed to be most effective in reducing frailty. While the physical activity interventions showed few adverse events, it is important to assess the safety of the environment and the health of the patient before beginning any activity, as most studies excluded participants with serious/unstable health conditions.

About the Project

As we age, and particularly as we become elderly, we are more vulnerable to setbacks such as illness, injury (e.g. falls) and other stresses. We recover more slowly from these events because of the physical process of aging. This vulnerability, which we often call ‘frailty’, can mean elderly people use the health care system more, but may experience negative outcomes, possibly related to treatment and possibly related to the problems causing the vulnerabilities themselves.

Prior to this study, there was no overview of tools or methods health care providers in the community could use to prevent frailty or make it less severe. For this reason we planned to review any interventions and/or policies that had been published and what they did for frail older people.

Project Team

Principal Investigators:

Martine Puts, RN, PhD — University of Toronto

Katherine McGilton, RN, PhD — University of Toronto

Co-Investigators:

Melissa Andrew, MD, MSc — Dalhousie University

Maureen Ashe, PhD, PT — University of British Columbia

Ana Patricia Ayala, MSc — University of Toronto

Howard Bergman, MD — McGill University

Jenny Ploeg, RN, PhD — McMaster University

Knowledge Users and Partners:

Christine Brenchley, OT — Ontario Society of Occupational Therapists

Francine Lemire, MD — The College of Family Physicians Canada

Barbara Liu, MD — Toronto Regional Geriatric Program

Mimi Lowi-Young, MHA, DBA, FACHE, FCCHL — Alzheimer Society Canada

Lorna MacGregor — Care Watch

Greg McIntosh — CBI Health

José Morais, MD — McGill University

Sandra McKay, PhD — VHA Home Health Care

Cheryl Reid-Haughian, RN, MHScN, CCHN(C) — Paramed Home Health Care

Gayle Seddon, RN — Toronto Central CCAC

Chris Sulway — Toronto Central LHIN

Suzan VanderBent, BA, BSW, MSW, MHSc, CHE — Home Care Ontario

Project Contact: Martine Puts — martine.puts@utoronto.ca

FRA 2015-A-07

Key words: frail elderly; aged; intervention; scoping review; community

Webinars

CFN Webinar (July 20, 2016): Scoping review of interventions to prevent and treat frailty in community dwelling older adults

Rationale, Objectives & Research Plan

Rationale: Currently, there is no overview of tools or methods health care providers in the community can use to prevent frailty or make it less severe. We plan to review interventions and/or policies that have been published and what they do for frail older people.

Objectives: Our goal is to summarize the evidence that is available on the subject of preventing or reducing frailty and to find out whether these interventions or policies have had any effect on preventing or reducing frailty.

Research plan: We will conduct a scoping review; that is, we will systematically search peer-reviewed journal articles to find ways other researchers have used to prevent or reduce the level of frailty. We will also search the internet and other databases to find international policies on the same subject.

Communication to Patients

Key Findings:

There is not much research about the best ways to improve or prevent frailty
Physical activity, eating well, and improving your memory may help reduce your chances of being frail.
We need to do more research about ways that improve frailty, so that we are less vulnerable when we get sick
When we do research, we need to include caregivers and people with frailty so that they can give us their view of what being frail means to them.

Why was this study needed?

This study needed to be done because more people are getting old and are living at home, and we need to keep them as healthy and strong as possible. We looked at all the researchers doing work in this area to find out whether we could find the best way to do improve or prevent older adults from becoming frail.

How can these findings affect older adults living with frailty and/or family caregivers?

These findings tell older adults living with frailty and/or family caregivers that we need to do more work to figure out the best way to keep people healthy and strong as they get older
Doing that work means we need to include older adults living with frailty and/or their caregivers into planning studies and testing methods such as assessing the surveys we use in research to make sure they are clear.
Older adults living with frailty told us that we need to look at more than just physical exercise: keeping the brain active is important too and we need to find the best way to do that as well as keeping track of how one’s mood influences frailty.

Brief comment on type of study:

This study was a scoping review of the literature focused on ways to prevent or reduce frailty, and we looked at all the studies we could find in this area.
The studies we looked at were done on older adults with frailty who lived at home.
We found that people had looked at physical activity, diet, nutrition, and cognitive training as ways to improve or reduce frailty.
We summarized what we found and rated how good the methods were that researchers used when doing their studies.
We found out that more work needs to be done to really identify the best approaches to reducing or improving frailty.

Communication to Policy Makers

Key Findings:

There were few studies that examined how to prevent and delay further progression of frailty
Many studies that included physical activity (including the combinations with nutritional intervention and/or memory training) were effective in reducing the prevalence of frailty
All studies only focused on the older pre-frail or frail older adult, none included the care-giver

Why was this study needed?

In this review of the literature we reviewed the evidence of all the studies conducted so far to summarize the gaps and identify areas for future research

Suggestions on how administrators or policy makers could use the findings:

It is important to consider healthy lifestyles for aging well and how that can be promoted within the context of a particular policy or administrator role.
For existing programs, it may be good to consider how the caregiver can participate in the program as well to support adherence to exercise interventions (with or without the other interventions).

Brief comment on type of study:

In this scoping review of the literature, we examined what evidence there was on interventions aimed to prevent or reduce frailty in older community-dwelling adults.
While most studies focused on exercise and were effective, there were few studies that examined combinations of interventions such as exercise with nutrition and/or memory training. More research is needed.
None of the studies included caregivers. Future studies that include caregivers may enhance older adults’ adherence to an intervention, such as exercise, as well as improve the health of the caregiver.

Communication to Researchers

Key Findings:

Our review found that few studies examined how to prevent, delay, or slow the progression of frailty.
Many studies that included physical activity (alone and in combination with a nutritional intervention and/or memory training) reduced the prevalence of frailty.
All studies focused on the older adult that is pre-frail or living with frailty; no studies included caregivers.

Why was this study needed?

We reviewed the literature to understand the gaps in knowledge and areas for future research that will improve health and quality of life for older adults living with frailty.

Brief overview of the methodology:

Our scoping review identified 14 studies that had examined an intervention to reduce the level of frailty in older community-dwelling adults. Nine of the 14 studies showed that an intervention significantly reduced the level of frailty and/or prevalence of frailty. The effective interventions included exercise, nutrition, cognitive training, geriatric assessment and management and pre-habilitation. None of the studies included caregivers.

Potential impact of findings on clinical practice/patient care and how this impact might be measured:

The effective interventions included exercise, nutrition, cognitive training, geriatric assessment and management and pre-habilitation.
More research is needed to understand how frailty can be prevented or slowed. The literature is limited in generalizability by heterogeneous study populations, small sample sizes, and adults without cognitive impairment.
No study involved caregivers of older adults living with frailty. Caregivers may facilitate participation in the intervention study and may also benefit from the intervention.

Remaining knowledge/research gaps:

There is limited evidence about the prevention of frailty in older community-dwelling adults
Future research should focus on multicomponent interventions.

PUBLICATION CITATION:

Age Ageing. 2017 May 1;46(3):383-392. doi: 10.1093/ageing/afw247.