Community-dwelling Frail Older People Research Articles

1970 How can health care professionals understand and incorporate spirituality into Comprehensive Geriatric Assessment?

Abstract Introduction Little is known about how Health Care Professionals (HCPs) conducting Comprehensive Geriatric Assessment (CGA) assess spiritual needs. The aim of this study was to better understand how UK HCPs understand and incorporate assessment of spirituality into CGA for community dwelling frail older people. Methods Semi-structured interviews were undertaken with HCPs who regularly undertake CGA in the community as well as Anna Chaplains (ACs) whose remit is to provide chaplaincy to community dwelling older people. An inductive approach was taken using a topic guide to structure the interviews. Thematic analysis was undertaken using NVIVO. Ethics approval was granted through St Augustine’s College of Theology. Results Three HCPs and two ACs were interviewed. Three themes emerged. Firstly, that spiritual assessment needs time, trust and skill and cannot be established using checklists. Assessment hinges on building a rapport between the patient and HCP. HCPs and ACs suggested potential questions that could support assessment of spiritual needs. Secondly, supporting spirituality is focused on sustaining identity, fostering hope and encouraging spiritual growth. Finally, health care professionals lacked confidence and understanding in how to recognise and meet spiritual needs. Several suggestions were made as to how to address this. Conclusions All participants agreed that incorporating assessment of spirituality into CGA was important but that doing so effectively requires understanding and skill. The questions suggested by participants mapped well onto existing models of spirituality in ageing and frailty. Study findings could be used to develop training for HCPs undertaking CGA.

The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review

BackgroundThe global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people.MethodsThe following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention.ResultsOf the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression.ConclusionsFew studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions.Systematic review registrationPROSPERO ID of CRD42022348064.

Translation and Validation of the Swedish Version of the Tilburg Frailty Indicator.

The Tilburg Frailty Indicator (TFI) is a questionnaire with 15 questions designed for screening for frailty in community-dwelling older people. TFI has a multidimensional approach to frailty, including physical, psychological, and social dimensions. The aim of this study was to translate TFI into Swedish and study its psychometric properties in community-dwelling older people with multimorbidity. A cross-sectional study of individuals 75 years and older, with ≥3 diagnoses of the ICD-10 and ≥3 visits to the Emergency Department in the past 18 months. International guidelines for back-translation were followed. Psychometric properties of the TFI were examined by determining the reliability (inter-item correlations, internal consistency, test-retest) and validity (concurrent, construct, structural). A total of 315 participants (57.8% women) were included, and the mean age was 83.3 years. The reliability coefficient KR-20 was 0.69 for the total sum. A total of 39 individuals were re-tested, and the weighted kappa was 0.7. TFI correlated moderately with other frailty measures. The individual items correlated with alternative measures mostly as expected. In the confirmatory factor analysis (CFA), a three-factor model fitted the data better than a one-factor model. We found evidence for adequate reliability and validity of the Swedish TFI and potential for improvements.

Integrating health promotion with and for older people - eHealth (IHOPe) – evaluating remote integrated person-centred care

BackgroundHealthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People – eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals.MethodsThe IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019–05364, Dnr 2020–03550, Dnr 2021–03255).DiscussionThe findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location.Trial registrationClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

The predictive ability of the three times stand and walk test to determine frailty and its association with fear of falling, cognitive function in community-dwelling older adults.

The three-time stand and walk test (TTSW) is a complex functional task used to determine muscle strength, balance, and fall risk in older individuals. This study hypothesized that TTSW is an appropriate tool for detecting frailty related to falls and the cognition of community-dwelling older adults. The study objectives were to 1) assess the ability of the TTSW to determine frailty by exploring the optimal cut-off score and 2) investigate the correlations between TTSW outcomes with falls and cognitive function in 118 community-dwelling older adults. The demographic data of eligible participants were assessed, and the participants were diagnosed with frailty based on the frailty phenotype. The participants then completed the Frail Non-Disabled (FiND) Questionnaire, TTSW, Falls Efficacy Scale-International (FES-I), and Mini-Mental State Examination Thai version (MMSE-Thai 2002). The results demonstrated that the TTSW outcomes were significantly correlated with FiND, FES-I, and MMSE-Thai 2002 (rho = .705 and r = .482 and -.510, respectively, p < .001). Moreover, a TTSW time of 18 s or longer had a good ability to indicate frailty in older individuals (sensitivity = 88.41, specificity = 83.67, and area under the receiver operating characteristic curve = .926). Implementing this tool in a community setting may be useful for the initial screening, monitoring, and referral of data by healthcare professionals. A cut-off TTSW time of 18 s or longer was the optimal criterion to indicate frailty in community-dwelling older people.

Untangling the interrelatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Effect of Home-Based Training with a Daily Calendar on Preventing Frailty in Community-Dwelling Older People during the COVID-19 Pandemic.

It has been reported that marked decreases in physical activity including social activities, deterioration in eating habits and mental health, and an increase in frailty have occurred during the COVID-19 pandemic. This study aimed to devise a method to prevent the onset and progression of frailty during the COVID-19 pandemic and to verify its effect. The subjects were 111 community-dwelling older people who answered questionnaires before and after the intervention. A calendar incorporating 31 different tasks, one for each day, was created as an intervention tool with the aim of improving motor, oral, and cognitive functions. The intervention group (n = 49) participants performed these tasks every day for 3 months. The primary outcome was the Kihon checklist (KCL) score. When the amount of change in the KCL score before and after 3 months was compared between the two groups, no difference in the total score was observed between the two groups; however, the intervention group showed significantly improved cognitive function in the KCL sub-domain. In the intervention group, the number of pre-frailty and frailty patients decreased significantly after the intervention compared to before the intervention. These results suggest that the use of the calendar created in this study during the COVID-19 pandemic could prevent decreased cognitive function in the KCL sub-domain and could help prevent the onset and progression of pre-frailty and frailty.

The home environment as fall risk factors among community-dwelling frail older people: A systematic review

The home environment as fall risk factors among community-dwelling frail older people: A systematic review

Mobility training for increasing mobility and functioning in older people with frailty.

Mobility training for increasing mobility and functioning in older people with frailty.

Oral Factors as Predictors of Frailty in Community-Dwelling Older People: A Prospective Cohort Study.

The purpose of this prospective cohort study was to identify predictors for frailty among possible oral factors in community-dwelling older people. Ninety-seven participants (≥60 years old) without frailty at baseline were included and assigned to either the robust or the frailty group after 2-year follow-up. The frailty was defined using the Japan Cardiovascular Health Study index. The numbers of present and functional teeth and periodontal disease severity were recorded. Bacterial counts on the dorsum of the tongue, oral moisture, tongue pressure, occlusal force, masticatory ability, and the oral diadochokinesis (ODK) rate were measured. Swallowing function, along with psychosocial status, relationships with communities and people, nutritional status, medical history, and comorbidities were evaluated using a questionnaire. The newly identified frailty group at follow-up showed significantly lower values in the number of teeth present, ODK/ta/sound and ODK/ka/sound rates, and clinical attachment level at baseline compared to the robust group. A logistic regression model showed a significantly negative association between the ODK/ta/sound rate at baseline and the incidence of frailty. Articulatory oral motor skill was found to be a predictor of frailty after two years.

Perda de função mastigatória e risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo

Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.

Worsening frailty in community-dwelling older people with hypertension and associated factors

Resumo Objetivo Estimar a prevalência e fatores associados à piora da fragilidade em idosos com hipertensão arterial. Métodos Estudo quantitativo, longitudinal prospectivo e analítico. Realizado em idosos hipertensos comunitários mineiros. A amostragem foi probabilística, por conglomerados em duas etapas. A coleta de dados ocorreu no domicílio dos idosos em dois momentos. Foram analisadas variáveis demográficas, socioeconômicas e clínico-assistenciais. A fragilidade foi mensurada pela Escala de Fragilidade de Edmonton. Utilizou-se a regressão de Poisson com variância robusta para obter as razões de prevalência brutas e ajustadas Resultados Participaram do estudo 281 idosos, 23,1% apresentaram piora do seu estado de fragilidade. A prevalência de fragilidade passou de 38,0%, no ano base, para 31,2% na primeira onda. A piora da fragilidade foi associada a autopercepção negativa da saúde, à polifarmácia e à internação nos últimos 12 mese Conclusão Houve transição entre os estados de fragilidade. Um contingente importante dos idosos apresentou piora da fragilidade.

Mapping instruments for assessing and stratifying frailty among community-dwelling older people: a scoping review

ObjectiveTo map in the current literature instruments for the assessment and stratification of frailty in community-dwelling older people, as well as to analyse them from the perspective of the Brazilian...

\u2018Don\u2019t forget the mouth!\u2019: a process evaluation of a public oral health project in community-dwelling frail older people

BackgroundOlder people are encouraged to remain community dwelling, even when they become care-dependent. Not every dental practice is prepared or able to provide care to community-dwelling frail older people, while their ability to maintain oral health and to visit a dentist is decreasing, amongst others due to multiple chronic diseases and/or mobility problems. The public oral health project ‘Don’t forget the mouth! (DFTM!) aimed to improve the oral health of this population, by means of early recognition of decreased oral health as well as by establishing interprofessional care. A process evaluation was designed to scientifically evaluate the implementation of this project.MethodsThe project was implemented in 14 towns in The Netherlands. In each town, health care professionals from a general practice, a dental practice, and a homecare organization participated. The process evaluation framework focused on fidelity, dose, adaptation, and reach. Each of the items were examined on levels of implementation: macro-level, meso-level, and micro-level. Mixed methods (i.e., quantitative and qualitative methods) were used for data collection.ResultsThe experiences of 50 health care professionals were evaluated with questionnaires, 22 semi-structured interviews were conducted, and the oral health of 407 community-dwelling frail older people was assessed. On each level of implementation, oral health care was integrated in the daily routine. On macro-level, education was planned (dose, adaption), and dental practices organized home visits (adaption). On meso-level, health care professionals attended meetings of the project (fidelity), worked interprofessionally, and used a screening-referral tool of the project DFTM! in daily practice (dose, adaption, reach). On micro-level, the frail older people participated in the screening of oral health (fidelity, dose), had their daily oral hygiene care observed (adaption) and supported if necessary, and some had themselves referred to a dental practice (reach). The semi-structured interviews also showed that the project increased the oral health awareness amongst health care professionals.ConclusionsThe project DFTM! was, in general, implemented and delivered as planned. Factors that contributed positively to the implementation were identified. With large-scale implementation, attention is needed regarding the poor accessibility of the oral health care professional, financial issues, and increased work pressure.Trial registration The Netherlands Trial Register NTR6159, registration done on December 13th 2016. URL: https://www.trialregister.nl/trial/6028

Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: a cross-sectional study of Urban Health Centres Europe (UHCE)

BackgroundFrailty is an age-related condition resulting in a state of increased vulnerability regarding functioning across multiple systems. It is a multidimensional concept referring to physical, psychological and social domains. The purpose of this study is to identify factors (demographic characteristics, lifestyle factors and health indicators) associated with overall frailty and physical, psychological and social frailty in community-dwelling older people from five European countries.MethodsThis cross-sectional study used baseline data from 2289 participants of the Urban Health Center European project in five European countries. Multivariable logistic regression models were used to assess associations of the factors with overall frailty and the three frailty domains.ResultsThe mean age was 79.7 (SD = 5.7). Participants who were older, were female, had secondary or equivalent education, lived alone, not at risk of alcohol use, were less physically active, had multi-morbidity, were malnourished or with a higher level of medication risk, had higher odds of overall frailty (all P < 0.05). Age was not associated with psychological and social frailty; sex was not associated with social frailty; smoking and migration background was not associated with overall frailty or any of its domains. There existed an interaction effect between sex and household composition regarding social frailty (P < 0.0003).ConclusionsThe present study contributed new insights into the risk factors for frailty and its three domains (physical, psychological and social frailty). Nurses, physicians, public health professionals and policymakers should be aware of the risk factors of each type of frailty. Furthermore, examine these risk factors more comprehensively and consider overall frailty as well as its three domains in order to further contribute to decision-making more precisely on the prevention and management of frailty.Trial registrationThe intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017.

Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity.

ObjectiveThe Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI.MethodsWe conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication.ResultsIn total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test–retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) >0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization).ConclusionSince population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.

Frailty screening among older adults receiving home care packages: a study of feasibility and prevalence.

Home care packages (HCPs) aim to support older people to remain in their homes for as long as possible. Early detection and management of frailty in community-dwelling older people may prevent or delay transfer to residential aged care. This suggests that it is important to establish mechanisms for identifying frailty among older adults. This study examined the feasibility of obtaining self-reported level of frailty from a sample of older adults receiving HCPs from an Australian aged care provider. The prevalence of frailty and sociodemographic and clinical correlates were assessed. Customers aged ≥65 years receiving an HCP from an aged care and disability service provider in New South Wales (n=158; 53.5% consent rate) completed a survey during their scheduled visit. The mean (±s.d.) total score on the Edmonton Frail Scale was 7.3±2.4 (range 1-13). The prevalence of frailty was 45% (5% 'severe frailty', 14% 'moderate frailty', 26% 'mild frailty'). Clients who had fallen in the past year had, on average, a 1.0-point higher frailty score (95% confidence interval 0.16-1.90) than those who had not. Given the high proportion of adults in our sample who were identified as frail, regular standardised assessments of frailty may assist community aged care providers to provide early intervention to reduce the risk of falls within this group of clients.

Fruit and Vegetable Consumption and Incident Prefrailty and Frailty in Community-Dwelling Older People: The English Longitudinal Study of Ageing.

Background: There is limited evidence in the literature regarding associations between fruit and vegetable consumption and risk of frailty. Objective: To examine associations between fruit and vegetable consumption and risk of incident frailty and incident prefrailty/frailty. Design: A prospective panel study. Setting and Subjects: 2634 non-frail community-dwelling men and women aged 60 years or older from the English Longitudinal Study of Ageing (ELSA). Methods: Fruit and vegetable consumption/day was measured using a self-completion questionnaire at baseline. Frailty status was measured at baseline and follow-up was based on modified frailty phenotype criteria. Four-year incident frailty was examined among 2634 robust or prefrail participants, and incident prefrailty/frailty was measured among 1577 robust participants. Results: Multivariable logistic regression models adjusted for age, gender, and other confounders showed that fruit and vegetable consumption was not associated with incident frailty risks among robust or prefrail participants. However, robust participants consuming 5–7.5 portions of 80 g per day (odds ratio (OR) = 0.56, 95% confidence interval (CI) = 0.37–0.85, p < 0.01) and 7.5–10 portions per day (OR = 0.46, 95%CI = 0.27–0.77, p < 0.01) had significantly lower risk of incident prefrailty/frailty compared with those consuming 0–2.5 portions/day, whereas those consuming 10 or more portions/day did not (OR = 1.10, 95%CI = 0.54–2.26, p = 0.79). Analysis repeated with fruit and vegetable separately showed overall similar results. Conclusions: Robust older adults without frailty who eat current U.K. government recommendations for fruit and vegetable consumption (5–10 portions/day) had significantly reduced risks of incident prefrailty/frailty compared with those who only eat small amount (0–2.5 portions/day). Older people can be advised that eating sufficient amounts of fruit and vegetable may be beneficial for frailty prevention.

Effectiveness of a far-infrared low-temperature sauna program on geriatric syndrome and frailty in community-dwelling older people.

AimAlthough it is known that geriatric syndrome is associated with the development of frailty, it is not known whether an amelioration of geriatric syndrome also improves shared risk factors and frailty.MethodsIn total, 67 community‐dwelling older people (79.6 ± 6.5 years, 49 women) participated in this study (41 were classified as pre‐frail and 26 as frail). We analyzed indices of physical frailty and cognitive depression, exercise tolerance and health‐related quality of life as frailty related indices, and the participants completed a questionnaire regarding common geriatric symptoms (cold extremities, leg edema, breathlessness, urinary incontinence, chronic headache, chronic pain, a sense of numbness, anorexia, constipation, insomnia and skin trouble) using numeric ratings. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study (J‐CHS) criteria. The participants then underwent a far‐infrared low‐temperature sauna (FILTS) program twice a week for 3 months and the above parameters were reassessed.ResultsAfter the FILTS program, there were significant differences in usual walking speed, peak oxygen uptake, Geriatric Depression Scale‐15, health‐related quality of life and the severity of several geriatric symptoms. Of the 67 participants, 18 showed improvements in their J‐CHS frailty score, 47 showed no change and two showed reductions. Linear regression analysis showed that the change in the numeric rating of the coldness of extremities (B = −0.105, P = 0.013) and the cumulative numeric rating for geriatric syndromes (B = 0.044, P < 0.001) were independent determinants of the change in the J‐CHS score.ConclusionsA 3‐month FILTS program ameliorates geriatric syndrome, the severity of frailty and frailty related indices in older Japanese people. Geriatr Gerontol Int 2020; 20: 892–898.

Fall-related efficacy is associated with the progression of frailty in community-dwelling older people

The goal of this study was to verify the association between frailty and fall-related efficacy in community-dwelling older people by performing a cross-sectional and longitudinal data analysis. In this study, 339 people aged 65 years and older participated in a baseline survey. Furthermore, people who were not identified as frail in the baseline survey participated in a follow-up survey 6 months later. Frailty was assessed in the baseline and follow-up surveys after 6 months using the Kihon checklist. Fall-related efficacy was assessed at baseline using the short Falls Efficacy Scale International (short FES-I). Potential confounding factors, such as the lower limb functions and psychological functions, were also investigated at baseline. The association between frailty and short FES-I was analyzed using a logistic regression analysis adjusted for potential confounding factors. At baseline and the follow-up survey, 10.1% and 6.3% of the participants were judged to demonstrate frailty, respectively. The results of the baseline and follow-up data analysis showed that even if potential confounding factors were adjusted for, the short FES-I was significantly associated with frailty. Furthermore, the ability to distinguish the onset of frailty using the short FES-I was analyzed using a receiver operating characteristic curve, and the area under curve, sensitivity, and specificity values were 0.78, 0.92 and 0.56, respectively. A clear association between frailty and fall-related efficacy was thus observed, as indicated in the cross-sectional and longitudinal data analysis. Furthermore, based on the results of the longitudinal data analysis, the short FES-I was found to be able to predict the progression of frailty and it can thus be a useful screening tool for assessing frailty.