Multicomponent Intervention and Long‐Term Disability in Older Adults: A Nonrandomized Prospective Study

Abstract

BACKGROUND/OBJECTIVES To evaluate the long‐term association between a multicomponent intervention program and disability in socioeconomically vulnerable older adults. DESIGN This was a nonrandomized prospective intervention trial. SETTING The setting was a community. PARTICIPANTS Participants included older Koreans living alone or receiving government assistance from a low‐income program. INTERVENTION The intervention was a 24‐week multicomponent program compromising group exercise, nutritional supplementation, management of depression, deprescribing, and home hazard reduction (n = 187) versus usual care (n = 196). MEASUREMENTS The number of dependencies in 17 basic and instrumental activities of daily living was measured every 3 months for 30 months (range: 0–17; greater values indicated worse disability). Inverse probability weighting Poisson regression was used to model the number of dependencies to adjust for confounding bias and higher dropout rates of those with greater disability. RESULTS The study population had a mean age of 76 years, and 26% were men. During the 30‐month follow up, 17 died (n = 8, intervention; n = 9, control), 62 (n = 16, intervention; n = 46, control) were institutionalized or received nursing home care, and 34 (n = 15, intervention; n = 19, control) were lost to follow up. After inverse probability weighting, the mean number of dependencies at baseline was 1.21 and 1.29 for the intervention group and the control group, respectively (P = .80). The intervention group had fewer dependencies than the control group, but the difference was attenuated over time: 1.08 versus 1.60 at 6 months (P = .04), 1.29 versus 1.87 at 12 months (P = .03), 1.62 versus 2.17 at 18 months (P = .06), 2.08 versus 2.51 at 24 months (P = .18), and 2.73 versus 2.90 at 30 months (P = .67). CONCLUSION A 24‐week multicomponent intervention was associated with a slower progression of disability; however, the diminishing association from 24 months and beyond suggests that reassessment and intervention may be necessary. Due to a lack of randomization, our findings should be interpreted with caution.

Longitudinal Impact of Oral Health on Geriatric Syndromes and Clinical Outcomes in Community-dwelling Older Adults

“…nutrition; and geriatric management of potentially inappropriate medications, chronic diseases, cognitiveand mood problems [42,43]. The combination of the observations from the present study with those of previous reports allows the future assessment of the bene cial effects of community-based programs targeting older populations to improve oral health status on frailty and geriatric outcomes on top of dental health status per se.…”

Longitudinal impact of oral health on geriatric syndromes and clinical outcomes in community-dwelling older adults

“…We selected these three items to reflect the various facets of oral health including physical function in speaking (item 1), pain and discomfort (item 2), and psychosocial/psychological aspects (item 3) [8]. Recent reports indicate that frailty and geriatric syndromes can be managed even in resource-scarce rural communities through the applicate of multicomponent intervention programs including exercise; nutrition; and geriatric management of potentially inappropriate medications, chronic diseases, cognitive-and mood problems [46,47]. The combination of the observations from the present study with those of previous reports allows the future assessment of the beneficial effects of community-based programs targeting older populations to improve oral health status on frailty and geriatric outcomes on top of dental health status per se.…”

Clinical Frailty Scale, K-FRAIL questionnaire, and clinical outcomes in an acute hospitalist unit in Korea

“…Frailty frequently accompanies multimorbidity and functional dependency and may deteriorate longitudinally in cycles of frailty [ 5 ]. However, frailty and associated geriatric conditions can be managed with appropriate intervention programs to prevent adverse outcomes such as functional decline even in resource-scarce public health settings [ 6 , 7 ].…”