Frail Persons Research Articles

THE EFFECT OF A STRUCTURED NUTRITIONAL CARE PROGRAMME IN SWEDISH NURSING HOMES

Objective: Malnutrition with consequent weight loss is a well-known problem among older frail persons living in nursing homes. The objective of this study was to examine the effect of a structured ...

Multi-Domains Lifestyle Interventions Reduces Depressive Symptoms among Frail and Pre-Frail Older Persons: Randomized Controlled Trial.

We investigated the effect of multi-domain lifestyle (physical, nutritional, cognitive) interventions among frail and pre-frail community-living older persons on reducing depressive symptoms. Participants aged 65 and above were randomly allocated to 24 weeks duration interventions with nutritional supplementation (N=49), physical training (N=48), cognitive training (N=50), combination intervention (N=49) and usual care control (N=50). Depressive symptoms were assessed by the Geriatric Depression Scale (GDS-15) at baseline (0M), 3 month (3M), 6 month (6M) and 12 month (12M). Mean GDS scores in the control group increased from 0.52 (0M) and 0.54 (3M) to 0.74 (6M), and 0.83 (12M). Compared to the control group, interventions showed significant differences (∆=change) at 6M for cognitive versus control (∆=-0.39, p=0.021, group*time interaction p=0.14); physical versus control (∆ =-0.37, p=0.026, group*time interaction p=0.13), and at 12M for nutrition versus control (∆ =-0.46, p=0.016, group*time interaction p=0.15). The effect for combination versus control was significant at 6M (∆ =-0.43, p=0.020) and 12M (∆ =-0.51, p=0.005, group*time interaction p=0.026). Estimated 12-month cumulative incidence of depressive symptoms (GDS≥2) relative to control were OR=0.38, p=0.037 (nutrition); OR=0.71, p=0.40 (cognitive); OR=0.39, p=0.042 (physical training) and OR=0.38, p=0.037 (combination). Changes in gait speed and energy level were significantly associated with changes in GDS scores over time. Multi-domain interventions that reverse frailty among community-living older persons also reduce depressive symptomatology. Public health education and programmatic measures combining nutritional, physical and cognitive interventions for at-risk frail older people may likely benefit psychological wellbeing.

Development of radar-based system for monitoring of frail home-dwelling persons: A healthcare perspective

This interdisciplinary project aims to develop and assess the functional potential of radar technology in the care services. The project mainly has an exploratory character where the technological and functional potential of impulse-radar sensor are tested out in monitoring of elderly and disabled people living in their own home. Designing a non-invasive system for monitoring of movements of frail persons living at home is the main goal, with the intent of assessing health and functional status through monitoring of activities of daily life (ADL) and detecting potentially dangerous situations, not the least related to a long lie following falls.

Self-perceived coping resources of middle-aged and older adults – results of a large population-based study

ABSTRACTObjectives: Psychosocial resources (personal resources, social resources, and other) are important for coping with aging and impairment. The aim of this study was to describe the resources of older adults and to compare subgroups with frailty, complex health care needs, and/or mental disorders.Method: At the third follow-up of the large population-based German ESTHER study, 3124 elderly persons (aged 55–85) were included. Psychosocial resources were assessed during a home visit by trained study doctors by using a list of 26 different items. Resources were described for the total group, separated by sex, and for the three subgroups of persons with frailty, complex health care needs, and mental disorders.Results: Family, self-efficacy, and financial security were the most frequently reported resources of older adults. Women and men showed significant differences in their self-perceived resources. Personal resources (self-efficacy, optimism, mastery), social resources, and financial security were reported significantly less frequently by frail persons, persons with complex health care needs, and mentally ill older adults compared to non-impaired participants. Apart from external support, patients who experienced complex health care needs reported resources less frequently compared to frail and mentally ill patients.Conclusion: Coping resources in older adults are associated with sex and impairment. Evaluation and support of personal resources of frail or mentally ill persons or individuals with complex health care needs should be integrated in the therapeutic process.

Older persons’ and their families’ experience with live-in foreign home care workers. A grounded theory study

Background: Live-in arrangements with migrant care workers have considerably increased over the last years since they allow older frail persons to age-in-place despite functional limitations. However, little is known about the ramifications live-in care arrangements for families. Aim: The aim of the study was to investigate families’ experience with live-in migrant care workers and indicators of quality from their perspective. Method: Constructivist grounded theory study with 22 families who were recruited via care agencies in the German-speaking part of Switzerland and participated in 29 individual or dyadic interviews. Results: Live-in care by migrant care workers has potentially positive ramifications for older persons and their families, but only so if families, first, reach a consensus about the need for the employment of migrant care workers; second, experience them as competent; and third, mutually forge relationships and negotiate daily life. A successful care arrangement occurs when there is a relational fit among those involved, which leaves families feeling cared for, safe and relieved. They experience a renewed stability in their family system, enriching relationships, and assuredness about the quality present in the care situation. Conclusions: A successful care arrangement is the result of relationships that have been actively created and a negotiated shared existence in a family-like network. It has a positive effect on the well-being of those receiving care and their family members. The family-like network needs competent support.

Community-Dwelling Older People’s Dietary Habits, Calorie Intake and Calorie Expenditure and their Relationship with Frailty

Aim: to describe dietary habits and calorie expenditure in a community-dwelling older population, as well as to assess the relationship between these habits and frailty and pre-frailty status. Methods: An observational, population-based, cross-sectional study was performed among community-dwelling people aged 75 years and older. Frailty was established according to Fried criteria, dietary habits were assessed by a validated food frequency consumption questionnaire, physical activity and calorie expenditure were estimated through the International Physical Activity Questionnaire. Results: A total of 324 people were recruited (170 men and 154 women), with a mean age of 80.1 (3.5) years, and 94.6% considered as well nourished. In women, BMI was higher in frail and pre-frail than in robust (30, 30, and 26, respectively; p < 0.001). Study sample tended to have a diet rich in nuts, fruits and vegetables. No differences in protein intake between frail and non-frail persons were observed, but frail persons had a lower intake of salads, nuts, fruits and fibre, as well as alcohol. Frail persons had a lower calorie intake and much lower calorie expenditure than non-frail persons, resulting in a greater positive energy balance. Conclusion: In an older population with sufficient calorie and protein intake, lower micronutrient intake of nuts, fruits and vegetables is a risk factor for frailty. Low physical activity is also related to frailty and predisposes to positive energy balance and obesity. Health professionals must encourage older people to exercise regularly and maintain good dietary habits including both good calorie and protein intake and good micronutrient intake of fruits and vegetables.

Informal long-term care for erderly and frail persons

Population aging is the main driver of growing demand for long-term care which results in increasing pressures on public finances. The informal care for elderly and frail persons produces many benefits and creates savings in the national budget. Nevertheless, little is known in Croatia about the problems faced by informal care providers. This Newsletter presents data on informal care coverage, indicates the available rights of informal care providers and recipients in Croatia, and proposes measures to improve the national system of informal care for elderly and frail persons based on examples from other EU Member States.

Association between nutritional status and quality of life in frail community-dwelling older persons

Association between nutritional status and quality of life in frail community-dwelling older persons

Cognitive Function in Individuals With Physical Frailty but Without Dementia or Cognitive Complaints: Results From the I-Lan Longitudinal Aging Study

ObjectiveTo investigate if understated cognitive impairment existed in individuals with physical frail or earlier prefrail state but without cognitive complaints and the susceptible cognitive domains to the physical frailty. DesignA cross-sectional population-based community study. SettingI-Lan County of Taiwan. ParticipantsA total of 1839 community residents aged 50 years or older in the I-Lan Longitudinal Aging Study. InterventionNone. MeasurementsFrail status assessments by the Cardiovascular Health Study (CHS) criteria and a series of neuropsychiatric assessments, including the Mini-Mental State Examination (MMSE), the delay free recall in the Chinese Version Verbal Learning Test (CVVLT), the Boston Naming Test (BNT), the category (animal) Verbal Fluency Test (VFT), the Taylor Complex Figure Test (CFT), the digital backward (DB), and the Clock Drawing Test. ResultsAfter excluding those with significant global cognitive impairment, subjective cognitive complaints, or functional impairment, 1686 persons aged 50 to 89 years (mean 63.4 ± 8.9) were enrolled. The prevalence of prefrail and frail individuals was 40.2% and 4.9%, respectively. The prefrail and frail persons had significantly poorer performance in the MMSE and all neuropsychological tests. Slowness and weakness were the most significant frailty components associated with cognitive impairment. The prefrail and frail individuals showed a more dose-dependent risk for 1 or more cognitive domain impairments than the robust individuals (odds ratio [OR] 1.28 in prefrail individuals versus OR 1.79 in frail individuals). The susceptible cognitive domains in the prefrail state were mainly focused on the nonmemory domains. However, the frail individuals were more likely to have risks for impairment in both memory and nonmemory domains. ConclusionsEven without subjective cognitive complaints, higher risk of cognitive impairment is presented in the prefrail and frail individuals. The incremental impact of frailty on cognition and the susceptibility of nonmemory domain may provide a new view in evaluating the pathogenesis of the relationship between frailty and cognitive impairment.

Frailty in Older Adults: A Nationally Representative Profile in the United States.

Frailty assessment provides a means of identifying older adults most vulnerable to adverse outcomes. Attention to frailty in clinical practice is more likely with better understanding of its prevalence and associations with patient characteristics. We sought to provide national estimates of frailty in older people. A popular, validated frailty phenotype proposed by Fried and colleagues was applied to 7,439 participants in the 2011 baseline of the National Health and Aging Trends Study, a national longitudinal study of persons aged 65 and older. All measures drew on a 2-hour in-person interview. Weighted estimates of frailty prevalence were obtained. Fifteen percent (95% CI: 14%, 16%) of the older non-nursing home population is frail, and 45% is prefrail (95% CI: 44%, 47%). Frailty is more prevalent at older ages, among women, racial and ethnic minorities, those in supportive residential settings, and persons of lower income. Independently of these characteristics, frailty prevalence varies substantially across geographic regions. Chronic disease and disability prevalence increase steeply with frailty. Among the frail, 42% were hospitalized in the previous year, compared to 22% of the prefrail and 11% of persons considered robust. Hip, back, and heart surgery in the last year were associated with frailty. Over half of frail persons had a fall in the previous year. Our findings support the importance of frailty in late-life health etiology and potential value of frailty as a marker of risk for adverse health outcomes and as a means of identifying opportunities for intervention in clinical practice and public health policy.

The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review.

urinary incontinence (UI) is a common symptom among older people, with a higher prevalence among frail older persons living in nursing homes. Despite consequences such as reduced health and quality of life, many older people do not seek help for their symptoms, resulting in missed opportunity for treatment. the aim of this study was to investigate the evidence and the effect of conservative treatment of UI and the quality of life among older and frail older persons. a systematic review of randomised controlled studies and prospective, non-randomised studies was conducted, evaluating interventions of conservative treatment of UI in an older population (65 years or older). A total of 23 studies fulfilled the inclusion criteria and 9 were of high or moderate quality. Fourteen studies were of low quality and were therefore excluded from the analysis. documented and effective conservative treatments are available even for older persons with UI. Pelvic muscle exercise, physical training in combination with ADL, prompted voiding and attention training, and help to toilet are important treatments. In some studies, however, the evidence of effectiveness is limited. this systematic review concludes that there are conservative treatments for UI for older and frail older persons that reduce leakage and increase quality of life. There is however a need for further high-quality studies.

Incidence of Disability in Frail Older Persons With or Without Slow Walking Speed

ObjectiveTo identify the differences of incidence of disability between frail older persons with and without slow walking speed. DesignProspective cohort study. SettingJapanese community. ParticipantsA total of l4,081 older adults aged ≥65 years living in the community, participated in a baseline assessment and were followed for incidence of disability for 29.5 months. MeasurementsCare-needs certification in the national long-term care insurance system of Japan, physical frailty (slow walking speed, muscle weakness, exhaustion, low activity, weight loss), adjusted for several potential confounders such as demographic characteristics; Kaplan-Meier survival curves for incident disability by physical frailty with and without slow walking speed. ResultsDuring the follow-up period, 198 participants (4.9%) were certified as requiring long-term care insurance in accordance with incident disability. Participants who had prefrailty without slow walking speed (hazard ratio 1.86, 95% confidence interval 1.19–2.92), prefrailty with slow walking speed (3.62, 2.19–5.96), frailty without slow walking speed (4.33, 2.00–9.39), and frailty with slow walking speed (4.68, 2.72–8.05) at the baseline assessment had an increased risk of incident disability compared with nonfrail participants. In stratified analyses, frail older men and frail participants with low cognitive performance had the highest risk of incidence of disability. ConclusionThe presence of frailty or even prefrailty when older adults showed slow walking speed increased the risk of future disability in community-dwelling older adults.

A semantic approach for enhancing assistive services in ubiquitous robotics

The Ambient Intelligence (AmI) technologies have the potential to create intelligent environments with new generation of assistive services, enhanced with ubiquitous robots. These environments have the ability to be anticipatory, responsive and intelligent providers of assistive services anytime and anywhere. These services can assist frail persons effectively in their daily tasks. One of the main challenging research problems in assistive robotics is to endow ubiquitous robots with ability to pro-actively taking on some tasks to help humans in performing complex activities, by participating with them just as other humans do, in normal societies or organizations.In this paper, we propose a collective intelligence framework based on narrative reasoning and natural language processing. In the proposed approach, we propose a hybrid model that bridges together the Narrative Knowledge Representation Language (NKRL), from natural language processing field, and the HARMS (Humans, software Agents, Robots, Machines and Sensors) model, from multi-agent systems engineering field. This model is able to (i) drive the dialogues between humans, robots and smart devices, (ii) understand a complex situation, and (iii) trigger reactive actions, in the ubiquitous environment, according to given contexts.Two scenarios dedicated to the assistance of a frail person in a smart home equipped with a companion robot and smart objects are implemented and discussed for validation purposes of the proposed framework.

Searching for Innovative Design: Architectural Competitions in the Silvering Swedish Welfare State

The new millennium has seen an increased interest in appropriate housing for the senior part of the Swedish population, defined as those aged 65 years and older. In 2010, the Swedish government launched a 2-year program called “Growing Old, Living Well” that targeted the living conditions of not only older people with few or some needs for homecare services, but also the smaller group of dependent and frail older persons whose everyday living depends upon regular caregiving. The program promoted architectural competitions as a tool for innovation. This article assesses the outcome of 3 architectural competitions that were carried out by 3 municipalities in accordance with the program. It concludes that existing notions about appropriate space for aging populations prevailed, since the competition briefs evolved from existing data and consequently allowed for only a low degree of innovative thinking. Hence, the relationship between architectural design and older people's age-related needs was only addressed indirectly. Further work needs to be done in the area of housing for the Swedish silvering welfare state in order for this factor to become an essential criterion for creating innovative architecture and urban design.

Diabetes mellitus in elderly.

Diabetes mellitus (DM) frequency is a growing problem worldwide, because of long life expectancy and life style modifications. In old age (≥60–65 years old), DM is becoming an alarming public health problem in developed and even in developing countries as for some authors one from two old persons are diabetic or prediabetic and for others 8 from 10 old persons have some dysglycemia. DM complications and co-morbidities are more frequent in old diabetics compared to their young counterparts. The most frequent are cardiovascular diseases due to old age and to precocious atherosclerosis specific to DM and the most bothersome are visual and cognitive impairments, especially Alzheimer disease and other kind of dementia. Alzheimer disease seems to share the same risk factors as DM, which means insulin resistance due to lack of physical activity and eating disorders. Visual and physical handicaps, depression, and memory troubles are a barrier to care for DM treatment. For this, old diabetics are now classified into two main categories as fit and independent old people able to take any available medication, exactly as their young or middle age counterparts, and fragile or frail persons for whom physical activity, healthy diet, and medical treatment should be individualized according to the presence or lack of cognitive impairment and other co-morbidities. In the last category, the fundamental rule is “go slowly and individualize” to avoid interaction with poly medicated elder persons and fatal iatrogenic hypoglycemias in those treated with sulfonylureas or insulin.

Unrecognized heart failure and chronic obstructive pulmonary disease (COPD) in frail elderly detected through a near-home targeted screening strategy.

Reduced exercise tolerance and dyspnea are common in older people, and heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the main causes. We want to determine the prevalence of previously unrecognized HF, COPD, and other chronic diseases in frail older people using a near-home targeted screening strategy. Community-dwelling frail persons aged ≥65 years underwent a 2-step screening strategy. First, they received a questionnaire inquiring about dyspnea and exercise tolerance. Those with exercise intolerance and/or dyspnea were invited to visit their primary care physician's office for a screening program, including medical history taking, physical examination, blood tests, electrocardiography, spirometry, and echocardiography. The final diagnosis of every patient was determined by a panel consisting of 3 physicians. Of the 570 elderly who filled out the questionnaire, 395 (69%) had reduced exercise tolerance or dyspnea. Of these, 389 underwent the screening program: 127 (33.5%, 95% confidence interval, 28.9-38.4%) were newly diagnosed with HF (mainly HF with a preserved ejection fraction [23.5%]), and previously unrecognized COPD was detected in 16.8% (95% confidence interval, 13.4-20.9%). In total, 165 patients (43.9%) received a new diagnosis of either HF, COPD, or both. Other new diagnoses (in 32.7% of the screening program patients) included atrial fibrillation (1.8%), valvular disease (21.4%), (persisting) asthma (3.1%), anemia (12.7%), and thyroid disease (0.6%). No clear explanation for the complaints of 47 patients (12.2%) was found using our strategy. Unrecognized chronic diseases might be detected in community-dwelling frail elderly using a near-home screening strategy that is simple to implement. It remains to be proven, however, whether optimizing treatment of the newly detected diagnoses in this fragile population with multimorbidities and polypharmacy improves quality of life and reduces morbidity and mortality.

Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living.

Transcatheter aortic valve implantation (TAVI) represents a less invasive treatment option for elderly patients. Therefore, we aimed to determine the impact of frailty measured by the Katz Index of activities of daily living (ADL) on short- and long-term mortality after TAVI. Our study included 300 consecutive patients (mean age, 82±5 years) who had undergone TAVI at our institution (158 transapical, 142 transfemoral procedures). At baseline, 144 patients were impaired in at least one ADL and therefore defined as frail (Katz Index <6). Regarding in-hospital outcome, all serious complications except for stage 3 acute kidney injury were equally distributed in both groups, but early mortality was significantly higher in frail persons (5.5% vs. 1.3%, p=0.04 for immediate procedural mortality; 17% vs. 5.8%, p=0.002 for 30-day mortality; and 23% vs. 6.4%, p<0.0001 for procedural mortality). The risk-score-based 30-day mortality estimates (29% vs. 24% for log. EuroSCORE I, 9.5% vs. 7.5% for EuroSCORE II, and 8.8% vs. 5.9% for STS score) reflected neither the observed 30-day mortality in both groups nor the threefold risk elevation in frail patients. In contrast, the Katz Index <6 was identified as a significant independent predictor of long-term all-cause mortality by multivariate analysis (HR 2.67 [95% CI: 1.7-4.3], p<0.0001). During follow-up (median observation period 537 days) 56% of frail vs. 24% of non-frail patients died. Frailty status measured by the Katz Index represents a powerful predictor of adverse early and late outcome after TAVI, whereas commonly used risk scores lack calibration and discrimination in a TAVI-specific patient cohort. Therefore, we propose the incorporation of this simple and reproducible measure into pre-TAVI risk assessment.

Self-determination among frail older persons – a desirable goal older persons’ conceptions of self-determination

Purpose – Self-determination is governed by ethical and legal rights in western society. In spite of that, older people are still restricted by others in their decision-making processes. The purpose of this paper is to explore older persons’ different conceptions of self-determination. Design/methodology/approach – A qualitative phenomenographic interview study on frail older persons (n=15). Findings – Three categories emerged, showing the variations of conception of self-determination as experienced by frail older people: first, self-determination changes throughout life; second, self-determination is being an agent in one's own life; and third, self-determination is conditional. In summary, while self-determination is changeable throughout life, and older persons want to be their own agents, and struggle to be that, certain conditions must be met to make it possible for them to be able to exercise self-determination. Practical implications – Suggestions for supporting and strengthening frail older persons’ self-determination, and indirectly their well-being and health: to have a person-centered approach, treat them with dignity and respect and give them opportunities to influence and to feel involved; to improve their health literacy by, for example, supporting them with enough knowledge to be able to exercise self-determination; to make them feel safe and secure in relationships, such as with family and caregivers. Originality/value – This study explores frail older persons’ own conceptions of self-determination to be able to gain knowledge of how professionals can support them so that they may experience self-determination in life.

Are physically frail older persons more at risk of adverse outcomes if they also suffer from cognitive, social, and psychological frailty?

Frailty is considered a predictor for negative outcomes such as disability, decreased quality of life, and hospital admission. Frailty measures have been developed that include different dimensions. We examined whether people who are physically frail are more at risk for negative outcomes of frailty if they also suffer from psychological, cognitive, or social frailty. Frailty was measured at baseline by means of the Groningen Frailty Indicator (GFI), which comprises a physical, cognitive, social, and psychological dimension. Only frail persons were included in the study (GFI ≥ 5) that, in addition, had to be frail in the physical dimension (i.e., ≥1 on this dimension). IADL disability and quality of life were measured at baseline and at 12months. Hospital admission was assessed during this period. In this, physically frail sample effects of the other three frailty dimensions were studied in regression models. The sample (n=334, mean age 78.1, and range 70-92) included 40.1% frail men and 59.9% frail women. Overall, no additional effects for the cognitive, social, or psychosocial dimensions were found: other frailty dimensions did not have an additional impact on disability, quality of life, or hospital admission in people who already suffered from physical frailty. Higher scores of physical frailty were significantly related to IADL disability (p<0.05) and hospital admission (p<0.05). Additional analysis showed that the physical frailty score predicted IADL disability and hospital admission better than the GFI overall score. Results of this study suggest that persons, who are physically frail, according to the GFI, are not more at risk for negative outcomes of frailty (i.e., IADL disability, decreased quality of life, and hospital admission) if they in addition suffer from cognitive, social, or psychological frailty. In addition, for the prediction of IADL disability or hospital admission, the focus for screening should be on the physical frailty score instead of the GFI overall score including different dimensions.

Building a State Coalition for Nursing Home Excellence

This article describes the successful evolution of a state coalition for nursing home excellence that brought together organizations that had once worked in silos to improve the quality of care through the implementation of culture change for Arkansas' 240 nursing homes with 27,700 residents. The Coalition was established in 2004 when stakeholders were invited to participate in a retreat to explore how they could come together with a common goal to improve the care of older Arkansans. These stakeholders were encouraged to bring their organization's perspectives to the Coalition and determine ways to work with others. The continuous refinement of the Coalition's activities involved revisiting goals of the Coalition, assessing the need for other stakeholders, identifying gaps and overlaps in quality and culture change programming, and providing feedback to Coalition members. The Coalition stakeholders had the leadership to articulate and mobilize others around a common vision of improving quality of care in nursing homes through culture change. Over time, the Coalition members developed a willingness to share resources and to speak as one voice. Stakeholders from diverse organizations and governing bodies can come together to complement each other's work and collaborate on programs to build a better system of care for the frail and elderly persons across a state. The success of this statewide effort lends support for policies that encourage regional coalitions of providers to improve care.