Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines

Abstract

BackgroundAge-related frailty is a multidimensional dynamic condition associated with adverse patient outcomes and high costs for health systems. Several interventions have been proposed to tackle frailty. This correspondence article describes the journey through the development of evidence- and consensus-based guidelines on interventions aimed at preventing, delaying or reversing frailty in the context of the FOCUS (Frailty Management Optimisation through EIP-AHA Commitments and Utilisation of Stakeholders Input) project (664367-FOCUS-HP-PJ-2014). The rationale, framework, processes and content of the guidelines are described.Main textThe guidelines were framed into four questions – one general and three on specific groups of interventions – all including frailty as the primary outcome of interest. Quantitative and qualitative studies and reviews conducted in the context of the FOCUS project represented the evidence base. We followed the GRADE Evidence-to-Decision frameworks based on assessment of whether the problem is a priority, the magnitude of the desirable and undesirable effects, the certainty of the evidence, stakeholders’ values, the balance between desirable and undesirable effects, the resource use, and other factors like acceptability and feasibility. Experts in the FOCUS consortium acted as panellists in the consensus process. Overall, we eventually recommended interventions intended to affect frailty as well as its course and related outcomes. Specifically, we recommended (1) physical activity programmes or nutritional interventions or a combination of both; (2) interventions based on tailored care and/or geriatric evaluation and management; and (3) interventions based on cognitive training (alone or in combination with exercise and nutritional supplementation). The panel did not support interventions based on hormone treatments or problem-solving therapy. However, all our recommendations were weak (provisional) due to the limited available evidence and based on heterogeneous studies of limited quality. Furthermore, they are conditional to the consideration of participant-, organisational- and contextual/cultural-related facilitators or barriers. There is insufficient evidence in favour of or against other types of interventions.ConclusionsWe provided guidelines based on quantitative and qualitative evidence, adopting methodological standards, and integrating relevant stakeholders’ inputs and perspectives. We identified the need for further studies of a higher methodological quality to explore interventions with the potential to affect frailty.

Association between Frailty and Mortality, Falls, and Hospitalization among Patients with Hypertension: A Systematic Review and Meta-Analysis

“…Third, there were insufficient data focused on the predictive value of prefrailty for the negative health outcomes in people with hypertension. Given that hypertensive patients have a higher prevalence of prefrailty [ 19 ] and prefrailty is more likely to be reversed by appropriate intervention [ 20 ], data obtained in longitudinal studies that focus on prefrailty-related clinical outcome will be useful for risk stratification and prognosis improvement in hypertensive patients.…”

“…As an effective indicator to objectively reflect the health status and medical needs of older people [ 13 ], the association between frailty and prognosis among patients with hypertension is worthy of examination. Moreover, given that frailty could be improved by appropriate intervention, it is considered that its early detection would be important for expeditious intervention [ 20 ]. Therefore, the objective of the present meta-analysis was to comprehensively examine the association between frailty and relevant clinical outcomes among patients with hypertension and provide evidence for the management of this group of the population in the future.…”

Validation of “(fr)AGILE”: a quick tool to identify multidimensional frailty in the elderly

“…The idea to organize the 10 items of AGILE according to frailty domains derives from the need to briefly identify the more compromised domain (“risk domain”) to develop personalized intervention and prevention strategies. In fact, several interventions have been proposed to prevent, delay or reverse frailty in older people, such as physical exercise, nutritional supplementation, cognitive training and combined treatment [ 26 ]. Furthermore, several studies have also established the effectiveness of tailored management programs to prevent frailty progression [ 27 , 28 ].…”

Association between frailty and self-reported health following heart valve surgery

“…Currently, the PERFORM-TAVR trial is testing an intervention consisting of a home-based exercise programme in combination with nutritional supplements on physical performance [27] . Similarly, the FOCUS-recommendations suggest interventions to include physical activity, nutritional interventions or a combination, to prevent, delay or reverse frailty [28] . In general, though, there is a need for high-quality studies investigating interventions with the potential to affect frailty [28] .…”

“…Similarly, the FOCUS-recommendations suggest interventions to include physical activity, nutritional interventions or a combination, to prevent, delay or reverse frailty [28] . In general, though, there is a need for high-quality studies investigating interventions with the potential to affect frailty [28] . Consequently, to reverse and change outcomes among frail patients, interventions should be aimed at the specific problem areas.…”