A realist review to understand the efficacy and outcomes of interventions designed to minimise, reverse or prevent the progression of frailty

Abstract

Interventions to minimise, reverse or prevent the progression of frailty in older adults represent a potentially viable route to improving quality of life and care needs in older adults. Intervention methods used across European Innovation Partnership on Active and Healthy Ageing collaborators were analysed, along with findings from literature reviews to determine 'what works for whom in what circumstances'. A realist review of FOCUS study literature reviews, 'real-world' studies and grey literature was conducted according to RAMESES (Realist and Meta-narrative Evidence Synthesis: Evolving Standards), and used to populate a framework analysis of theories of why frailty interventions worked, and theories of why frailty interventions did not work. Factors were distilled into mechanisms deriving from theories of causes of frailty, management of frailty and those based on the intervention process. We found that studies based on resolution of a deficiency in an older adult were only successful when there was indeed a deficiency. Client-centred interventions worked well when they had a theoretical grounding in health psychology and offered choice over intervention elements. Healthcare organisational interventions were found to have an impact on success when they were sufficiently different from usual care. Compelling evidence for the reduction of frailty came from physical exercise, or multicomponent (exercise, cognitive, nutrition, social) interventions in group settings. The group context appears to improve participants' commitment and adherence to the programme. Suggested mechanisms included commitment to co-participants, enjoyment and social interaction. In conclusion, initial frailty levels, presence or absence of specific deficits, and full person and organisational contexts should be included as components of intervention design. Strategies to enhance social and psychological aspects should be included even in physically focused interventions.

Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults

“…However, an RET intensity as high as 80–95% 1-RM has been recommended to induce maximal muscle hypertrophy or muscle fiber adaptation [73,74], which is not allowed for most frail older adults, especially for the institutionalized residents who are more dependent and usually have lower exercise adherence rate due to cardiopulmonary dysfunction or physical limitations [75]. Therefore, physical activity exercises combining RET with aerobic exercises, balance training, and functional mobility training (i.e., MET) are recommended for older adults to improve physical function and prevent falls [64,76,77]. Most of the included RCTs in this meta-analysis employed RET with a moderate–to-high intensity of 50–80% 1-RM [48,49,50,51,56,58,61], whereas MET was mostly performed with a light-to-moderate intensity for frail older participants [26,41,42,45,46,52,54,59]; the results showed that PS plus MET as well as PS plus RET had significant effects on whole body mass, walking speed, and leg strength, which indicated that frail older adults responded favorably to PS plus MET in reversing or preventing frail status.…”

Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)

“…Multiple associations have been identified between psychological and mental discomfort and social factors contributing to higher levels of frailty and lower QoL by A3 researchers. Impairment in cognitive function is strongly related to frailty and is associated with impaired awareness of disease (insight), depression and disinhibition [42] while cognitive reserve (the ability of the brain to develop alternate cognitive strategies to solve a problem despite impaired cognition) is related to a better QoL [43,44,45]. Furthermore, anxiety and depression were associated with physical disability, lower QoL and a high health service uses (i.e., hospitalization in the last year, number of medical visits) [46].…”

“…The partners contributing to this multi-centre project are working on advancing knowledge of frailty detection, assessment, and management, including biological, clinical, cognitive and psychosocial markers, in order to change the paradigm of frailty care from acute intervention to prevention and rehabilitation. The outcomes include the generation of new guidelines and recommendations to increase success of interventions and the creation of a technological platform for EIP-AHA partners and stakeholders [45,61,62]. The guidelines and recommendations were piloted in five sites (Valencia in Spain, Milan in Italy, Coimbra in Portugal, Wroclaw in Poland and Birmingham in the UK).…”

The use of technology in the context of frailty screening and management interventions: a study of stakeholders’ perspectives

“…To change stakeholders’ perceptions on the value of technology solutions for frailty management, they must first understand that frailty is not necessarily a fixed state [9, 10] and that there are things that people can do to improve, or at least to manage their health and quality of life. Being clear about the benefits of knowing your frailty status and how you can manage, and even ameliorate that may promote interest in technological solutions.…”

“…Although there is no benchmark definition of frailty, many operational definitions have emerged over the past two decades, with two highly cited assessment tools being Fried’s phenotype [5, 6] and the accumulation of deficits model [7, 8]. Recent evidence suggests that frailty is a dynamic and transitional process and that there may be opportunities to reverse, manage or prevent its progression through intervention [9, 10].…”