Single versus multicomponent intervention in frail elderly: Simplicity or complexity as precondition for success?

Vliek, S.B.; Melis, René J. F.; Faes, Miriam C.; Golüke-Willemse, Gertie; Leest, B. J. de; Meeuwsen, E.J.; Raak, F.H.J.M. van; Schölzel-Dorenbos, C.J.M.; Rikkert, Marcel G M Olde

doi:10.1007/bf02982662

Cited by 12 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Osteoporosis and sarcopenia are closely linked because they are related to and/or are dependent on nutritional status and physical activity. 22 , 29 , 30 Reduced protein intake and consequent MN contribute to both bone mass loss 31 , 32 and weight loss and therefore to lean mass loss 22 and are thus predictive factors for osteoporosis, sarcopenia, and frailty. 31 …”

Section: Discussionmentioning

confidence: 99%

Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects

Valentini

Federici

Cianfarani

et al. 2018

CIA

View full text Add to dashboard Cite

IntroductionFrailty is a condition characterized by reduced resistance to low-level stress events, resulting from the progressive decline of multiple physiological systems observed with aging. Many factors can contribute to the pathogenesis of frailty, and nutritional status appears to play a key role. The objective of the study was to investigate the relationship between nutritional status, evaluated using Mini Nutritional Assessment (MNA), and frailty among older people.Patients and methodsAn observational study was carried out at the University Hospital “Tor Vergata” in Rome among patients aged 65 years or older, with or without hip fracture. The study sample included 62 patients hospitalized for a hip fracture and 50 outpatients without fracture. All subjects underwent blood sampling for laboratory assays and received a multidimensional geriatric evaluation comprising Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), Mini–Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and MNA. Comorbidity was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Muscle strength was measured by handgrip dynamometry, and frailty score was calculated using the Survey of Health, Ageing and Retirement in Europe-Frailty Index (SHARE-FI).ResultsApproximately 38% of the study population was frail, with the prevalence of frailty being greater among hospitalized older patients. Among frail subjects, 65% were at risk of malnutrition (RMN) and 10% were malnourished. The prevalence and RMN progressively diminished in the pre-frail group and not frail group. Nutritional status was closely associated with the degree of frailty, and in a logistic regression, MNA was the best variable predicting both pre-frailty and frailty.Discussion and conclusionMalnutrition contributes to the development of frailty. MNA can generate vital information to help identify a substantial part of both frail and pre-frail patients at low cost and care.

show abstract

Section: Discussionmentioning

confidence: 99%

Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects

Valentini

Federici

Cianfarani

et al. 2018

CIA

View full text Add to dashboard Cite

show abstract

“…These interventions can be combined with each other or with other (eg, pharmacological, hormonal, or cognitive) therapies to prevent or treat frailty 20. As frailty results from reaching a threshold of decline in different physiological systems, the approach to address frailty should act on multiple domains 13,21…”

Section: Introductionmentioning

confidence: 99%

Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic review

Dedeyne¹,

Deschodt

Verschueren

et al. 2017

CIA

222

175

View full text Add to dashboard Cite

BackgroundFrailty is an aging syndrome caused by exceeding a threshold of decline across multiple organ systems leading to a decreased resistance to stressors. Treatment for frailty focuses on multi-domain interventions to target multiple affected functions in order to decrease the adverse outcomes of frailty. No systematic reviews on the effectiveness of multi-domain interventions exist in a well-defined frail population.ObjectivesThis systematic review aimed to determine the effect of multi-domain compared to mono-domain interventions on frailty status and score, cognition, muscle mass, strength and power, functional and social outcomes in (pre)frail elderly (≥65 years). It included interventions targeting two or more domains (physical exercise, nutritional, pharmacological, psychological, or social interventions) in participants defined as (pre)frail by an operationalized frailty definition.MethodsThe databases PubMed, EMBASE, CINAHL, PEDro, CENTRAL, and the Cochrane Central register of Controlled Trials were searched from inception until September 14, 2016. Additional articles were searched by citation search, author search, and reference lists of relevant articles. The protocol for this review was registered on PROSPERO (CRD42016032905).ResultsTwelve studies were included, reporting a large diversity of interventions in terms of content, duration, and follow-up period. Overall, multi-domain interventions tended to be more effective than mono-domain interventions on frailty status or score, muscle mass and strength, and physical functioning. Results were inconclusive for cognitive, functional, and social outcomes. Physical exercise seems to play an essential role in the multi-domain intervention, whereby additional interventions can lead to further improvement (eg, nutritional intervention).ConclusionEvidence of beneficial effects of multi-domain compared to mono-domain interventions is limited but increasing. Additional studies are needed, focusing on a well-defined frail population and with specific attention to the design and the individual contribution of mono-domain interventions. This will contribute to the development of more effective interventions for frail elderly.

show abstract

“…1 Based on the predominant geriatric paradigm of multicausality, complex multifactorial interventions are generally considered to be more powerful in this population than single-component interventions because they can address more potential risk factors. 2 Complex interventions are difficult to develop, document, and reproduce. Randomized controlled trials (RCTs), which are required to demonstrate their effectiveness, are usually costly and challenging.…”

mentioning

confidence: 99%

“…5 Taken together, the various phases of the MRC framework may be of great value in geriatric research, although this framework has not yet been widely referenced in the geriatric literature. 2,[6][7][8] The MRC framework was used to guide the development and evaluation of a multifactorial fall prevention intervention for frail community-dwelling older persons, with and without cognitive impairment, and their informal caregivers. To the authors' knowledge, no fall prevention intervention has proven to be effective in frail communitydwelling patients with dementia or mild cognitive impairment.…”

mentioning

confidence: 99%

Developing and Evaluating Complex Healthcare Interventions in Geriatrics: The Use of the Medical Research Council Framework Exemplified on a Complex Fall Prevention Intervention

Faes

Reelick

Esselink

et al. 2010

J American Geriatrics Society

View full text Add to dashboard Cite

Geriatrics focuses on a variety of multiorgan problems in a heterogeneous older population. Therefore, most geriatric healthcare interventions are complex interventions. The UK Medical Research Council (MRC) has developed a framework to systematically design, evaluate, and implement complex interventions. This article provides an overview of this framework and illustrates its use in geriatrics by showing how it was used to develop and evaluate a fall prevention intervention. The consecutive phases of the framework are described: Phase I: Development. This phase began with a literature review, which provided the existing evidence and the theoretical understanding of the process of change. This understanding was further developed through focus groups with experts and interviews with patients and caregivers. The intervention was modeled using qualitative testing of the preliminary intervention through focus groups and through the completion of Delphi surveys by independent specialists. Phase II: Feasibility and piloting. In this phase, a pilot study was conducted in a group of patients and caregivers. The feasibility of the intervention and evaluation was also discussed in focus groups of participants and instructors. Phase III: Evaluation. The information from phases I and II shaped the design of a randomized controlled trial to test the effectiveness of the intervention. Phase IV: Dissemination. The purpose of the final phase is to examine the implementation of the intervention into practice. The MRC framework provides an innovative and useful methodology for the development and evaluation of complex geriatric interventions that deserves greater dissemination and implementation.

show abstract

Single versus multicomponent intervention in frail elderly: Simplicity or complexity as precondition for success?

Cited by 12 publications

References 14 publications

Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects

Frailty and nutritional status in older people: the Mini Nutritional Assessment as a screening tool for the identification of frail subjects

Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic review

Developing and Evaluating Complex Healthcare Interventions in Geriatrics: The Use of the Medical Research Council Framework Exemplified on a Complex Fall Prevention Intervention

Contact Info

Product

Resources

About