The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective

Adja, Kadjo Yves Cedric; Lenzi, Jacopo; Sezgin, Duygu; Ó’Caoimh, Rónán; Morini, Mara; Damiani, Gianfranco; Buja, Alessandra; Fantini, Maria Pia

doi:10.3389/fpubh.2020.599170

Cited by 23 publications

(31 citation statements)

References 128 publications

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“…Severe frailty typically occurs more often in women 25 , is observed in 12-24% of older adults and is age related 26 . Increasingly, frailty is seen as modifiable, even potentially preventable, thereby making it a target of treatment [27][28][29][30][31] . Trials of nutrition and physical exercise face challenges in relation to blinding, types of controls and measurement of dosing that can be more challenging than pharmaceutical studies, especially for well-tolerated compounds 27 .…”

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confidence: 99%

“…These challenges must be faced in sufficiently large, locally adapted, randomized controlled trials if the prospect of prevention or even mitigation is to be more than aspirational. For this, multicomponent programs will be important, including taking the social context into account 29 , something not always done 31 . Even so, caution is required: one indication that the path to success may be quite long is signaled by a multicomponent trial of metformin and exercise-instead of increasing, metformin attenuated some of the benefit associated with exercise 32 .…”

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The degree of frailty as a translational measure of health in aging

2021

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The degree of frailty as a translational measure of health in aging

2021

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“…Although our sample was balanced in terms of the distribution of age groups, it consisted predominantly of women (71.6%) and we could not verify statistical differences due to sex that were fund in other studies ( Roppolo et al, 2017 ; Navarro-Pardo et al, 2020 ; Rivan et al, 2020 ). Given that leisure activities were important predictors of CF and considering that these activities are very depending on wealth or economic level, we recognize as a limitation not having included a variable on the economic level of the participants, in order to verify its relationship with the CRI-q-Leisure time factor, and its predictive value on CF ( Adja et al, 2020 ; Scherrer and Morley, 2021 ). Studying the economic level in rural vs. urban environments could also overcome that.…”

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confidence: 99%

Cognitive reserve and mental health in cognitive frailty phenotypes: Insights from a study with a Portuguese sample

et al. 2022

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BackgroundResearch on prevalence of cognitive frailty phenotypes in community-dwelling older adults in different countries is important to estimate their prevalence and to determine the influence of cognitive reserve and mental health in order to prevent frailty. The aims of this study were to estimate the prevalence of reversible and potentially reversible cognitive frailty (R-CF, PR-CF) in a Portuguese sample of old adults and explore the associations between these phenotypes and demographic, comorbidity, social support, cognitive reserve and mental health factors.MethodsWe assessed frailty (Fried criteria) in 250 community-dwelling older adults (179 women) aged 60 years or over (mean 71.04 years) without dementia, neurological or psychiatric disorders. Subjective cognitive decline and Mild cognitive impairment were diagnosed according to standard criteria. The questionnaires Charlson Index, Medical Outcomes Study Social Support, Cognitive Reserve Index and General Health were used for assessing comorbidity, social support, cognitive reserve and mental health, respectively.ResultsPrevalence of R-CF was 14%, and that of PR-CF, 15.2%. Cognitive frailty profiles differed significantly in relation to education, comorbidity, mental health, and cognitive reserve, but not in age or sex. Multivariate logistic regression showed that age, sex, comorbidity, social support, mental health, and cognitive reserve together predicted R-CF and PR-CF (90% specificity 75% sensitivity) with significant OR for mental health and cognitive reserve.DiscussionCognitive reserve and mental health are important factors predicting R-CF and PR-CF. We recommend assessing these factors for early detection of cognitive frailty and promoting psychological well-being and lifestyles that increase cognitive reserve in adults.

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“…Such involvement requires that physicians ensure that the patient is cognitively oriented and sufficiently informed [ 50 ], which was also noted by the PCPs in our study. Since many older patients are cognitively impaired, it can be very difficult for them to be involved in accordance with a patient-centred care model [ 30 , 51 ]. Conflict of the wishes of patients and their relatives conflict with what PCPs consider to be the best medical decision can result in PCPs taking a more biomedical view rather than a patient-centred care approach when deciding the medical treatment [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

Nystrøm

Lurås

Midlöv

et al. 2021

BMC Health Serv Res

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Background Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. Methods The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. Results The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. Conclusions The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.

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The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective

Cited by 23 publications

References 128 publications

The degree of frailty as a translational measure of health in aging

The degree of frailty as a translational measure of health in aging

Cognitive reserve and mental health in cognitive frailty phenotypes: Insights from a study with a Portuguese sample

What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

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