Update on Interventions to Prevent or Reduce Frailty in Community-Dwelling Older Adults: a Scoping Review and Community Translation

Abstract

Purpose of Review With increasing interest in frailty prevention and management globally, this scoping review provides an update to the current knowledge on interventions to reduce frailty in community-dwelling older adults and its state of translation in real-world settings. Recent Findings Updating previous findings of 14 studies from 2000 to 2016 by Puts et al., we reviewed 10 additional studies from 2016 to 2018 and found that up to date, 18 of 24 studies overall showed effective interventions in preventing or reducing frailty (as the intervention target) in community-dwelling older adults. Multidimensional frailty definitions and a multi-domain approach have been increasingly employed for frailty identification and intervention. The effective interventions included various modalities of exercise training, nutrition education/program, cognitive training, geriatric assessment, and management coupled with psychosocial interventions/support that may sustain program participation. While resistance training was the most commonly employed modality of physical training, we did not find evidence that it is more effective than other modalities. Effective interventions can be delivered in a primary care or other community settings by multidisciplinary combination of professionals and volunteers. There has been better recognition of the need for community translation in frailty reduction in the developed countries, with initial policy efforts introduced in some countries. Summary To further the evidence-based and community translation, well-designed studies aimed at maximizing function and promoting aging in place using multi-domain interventions are essential. This will better inform comprehensive policies to address frailty prevention/reduction through appropriate health and social programs/services provision and financing.

A single-arm feasibility study of community-delivered Baduanjin (Qigong practice of the eight Brocades) training for frail older adults

“…There was also very good rapport between the instructors and participants which appeared to improve over the program. The social component [11] and ability of instructors to engage participants during and outside training were important. Since our participants were prefrail/frail older adults, they were at increased risk of hospitalization.…”

“…Different interventions to reduce frailty have been studied [8][9][10]. Recent reviews highlighted the importance of physical exercise in reducing frailty and improving function in prefrail/frail older adults [11,12]. Economic study also demonstrated that physical exercise is cost-effective in preventing the progression of frailty and disability in older adults living in the community [13].…”

Effectiveness of a group functional power training program for frail older adults implemented through neighbourhood senior centres – a randomised controlled study

“…A strategy to bridge the digital divide of some older people has been to pair them up with others in their family or neighbours who can help with digital access and engagement with the live online training program. While not speci cally measured in our study, the social engagement has been shown to be an important aspect of adherence to group training (8).…”

“…Frailty is not a contraindication to exercise but a reason to prescribe it. Frailty can be delayed or reversed through interventions where physical training is a key component, especially during the pre-frail stage (6)(7)(8). There is wide consensus for pre-frail or frail older people to be offered a physical activity program with a progressive, resistance training component (9,10).…”

A single-arm feasibility study of community-delivered Baduanjin (Qigong practice of the eight Brocades) training for frail older adults

“…Different interventions to reduce frailty have been studied (8)(9)(10). Recent reviews highlighted the importance of physical exercise in reducing frailty and improving function in prefrail/frail older adults (11,12). Economic study also demonstrated that physical exercise is cost-effective in preventing the progression of frailty and disability in older adults living in the community (13).…”