Interventions to prevent disability in frail community-dwelling elderly: a systematic review

Ramon Daniels, Erik van Rossum, Luc de Witte, Gertrudis I J M Kempen, Wim van den Heuvel, Ramon Daniels, Erik van Rossum, Luc de Witte, Gertrudis I J M Kempen, Wim van den Heuvel

Abstract

Background: There is an interest for intervention studies aiming at the prevention of disability in community-dwelling physically frail older persons, though an overview on their content, methodological quality and effectiveness is lacking.

Methods: A search for clinical trials involved databases PubMed, CINAHL and Cochrane Central Register of Controlled Trials and manually hand searching. Trials that included community-dwelling frail older persons based on physical frailty indicators and used disability measures for outcome evaluation were included. The selection of papers and data-extraction was performed by two independent reviewers. Out of 4602 titles, 10 papers remained that met the inclusion criteria. Of these, 9 were of sufficient methodological quality and concerned 2 nutritional interventions and 8 physical exercise interventions.

Results: No evidence was found for the effect of nutritional interventions on disability measures. The physical exercise interventions involved 2 single-component programs focusing on lower extremity strength and 6 multi-component programs addressing a variety of physical parameters. Out of 8 physical exercise interventions, three reported positive outcomes for disability. There was no evidence for the effect of single lower extremity strength training on disability. Differences between the multi-component interventions in e.g. individualization, duration, intensity and setting hamper the interpretation of the elements that consistently produced successful outcomes.

Conclusion: There is an indication that relatively long-lasting and high-intensive multicomponent exercise programs have a positive effect on ADL and IADL disability for community-living moderate physically frail older persons. Future research into disability prevention in physical frail older persons could be directed to more individualized and comprehensive programs.

Figures

Figure 1
Figure 1
Progress of search for relevant trials.

References

    1. Aminzadeh F, Dalziel WB, Molnar FJ. Targeting frail older adults for outpatient comprehensive geriatric assessment and management services: an overview of concepts and criteria. Rev Clin Gerontol. 2002;12:82–92. doi: 10.1017/S0959259802121101.
    1. Storey E, Thomas RL. Understanding and ameliorating frailty in the elderly. Topics in Geriatric Rehabilitation. 2004;20:4–13.
    1. Espinoza S, Walston JD. Frailty in older adults: insights and interventions. Cleve Clin J Med. 2005;72:1105–1112.
    1. Hooi WC, Bergman H. A review on models and perspectives on frailty in older persons. SGH Proceedings. 2005;14
    1. Markle-Reid M, Browne G. Conceptualizations of frailty in relation to older adults. J Adv Nurs. 2003;44:58–68. doi: 10.1046/j.1365-2648.2003.02767.x.
    1. Slaets JP. Vulnerability in the elderly: frailty. Med Clin North Am. 2006;90:593–601. doi: 10.1016/j.mcna.2006.05.008.
    1. Hardy SE, Dubin JA, Holford TR, Gill TM. Transitions between states of disability and independence among older persons. Am J Epidemiol. 2005;161:575–584. doi: 10.1093/aje/kwi083.
    1. Boyd CM, Xue QL, Simpson CF, Guralnik JM, Fried LP. Frailty, hospitalization, and progression of disability in a cohort of disabled older women. Am J Med. 2005;118:1225–1231. doi: 10.1016/j.amjmed.2005.01.062.
    1. Gill TM, Allore H, Holford TR, Guo Z. The development of insidious disability in activities of daily living among community-living older persons. Am J Med. 2004;117:484–491. doi: 10.1016/j.amjmed.2004.05.018.
    1. Cutler DM. Declining disability among the elderly. Health Affairs. 2001;20:11–27. doi: 10.1377/hlthaff.20.6.11.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–156.
    1. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59:255–263.
    1. Rockwood K. What would make a definition of frailty successful? Age Ageing. 2005;34:432–434. doi: 10.1093/ageing/afi146.
    1. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Jr, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004;52:625–634. doi: 10.1111/j.1532-5415.2004.52174.x.
    1. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, Ershler WB, Harris T, Fried LP. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54:991–1001. doi: 10.1111/j.1532-5415.2006.00745.x.
    1. Jette AM. Towards a common language for function, disability and health. Physical Therapy. 2006;86:726–734.
    1. Avlund K. Disability in old age. Longitudinal population-based studies of the disablement process. Dan Med Bull. 2004;51:315–349.
    1. Covinsky K. Aging, arthritis, and disability. Arthritis Rheum. 2006;55:175–176. doi: 10.1002/art.21861.
    1. van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 1999;24:1113–1123. doi: 10.1097/00007632-199906010-00011.
    1. Kretser AJ, Voss T, Kerr WW, Cavadini C, Friedmann J. Effects of two models of nutritional intervention on homebound older adults at nutritional risk. Journal of the American Dietetic Association. 2003;103:329–336. doi: 10.1016/S0002-8223(02)00088-3.
    1. Chin A Paw MJ, de Jong N, Schouten EG, Hiddink GJ, Kok FJ. Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: a randomized controlled trial. Arch Phys Med Rehabil. 2001;82:811–817. doi: 10.1053/apmr.2001.23278.
    1. Payette H, Boutier V, Coulombe C, Gray-Donald K. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. J Am Diet Assoc. 2002;102:1088–1095.
    1. Chandler JM, Duncan PW, Kochersberger G, Studenski S. Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Arch Phys Med Rehabil. 1998;79:24–30. doi: 10.1016/S0003-9993(98)90202-7.
    1. Worm CH, Vad E, Puggaard L, Stovring H, Lauritsen J, Kragstrup J. Effects of a multicomponent exercise program on functional ability in community-dwelling frail older adults. Journal of the aging and physical activity. 2001. pp. 414–424.
    1. King MB, Whipple RH, Gruman CA, Judge JO, Schmidt JA, Wolfson LI. The Performance Enhancement Project: improving physical performance in older persons. Arch Phys Med Rehabil. 2002;83:1060–1069. doi: 10.1053/apmr.2002.33653.
    1. Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med. 2002;347:1068–1074. doi: 10.1056/NEJMoa020423.
    1. Boshuizen HC, Stemmerik L, Westhoff MH, Hopman-Rock M. The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly. J Aging Phys Act. 2005;13:5–22.
    1. Timonen L, Rantanen T, Makinen E, Timonen TE, Tormakangas T, Sulkava R. Effects of a group-based exercise program on functional abilities in frail older women after hospital discharge. Aging Clin Exp Res. 2006;18:50–56.
    1. Binder EF, Schechtman KB, Ehsani AA, Steger-May K, Brown M, Sinacore DR, Yarasheski KE, Holloszy JO. Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc. 2002;50:1921–1928. doi: 10.1046/j.1532-5415.2002.50601.x.
    1. Pahor M, Blair SN, Espeland M, Fielding R, Gill TM, Guralnik JM, Hadley EC, King AC, Kritchevsky SB, Maraldi C, et al. Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006;61:1157–1165.
    1. Olde Rikkert MG, Rigaud AS. Malnutrition research: high time to change the menu. Age Ageing. 2003;32:241–243. doi: 10.1093/ageing/32.3.241.
    1. van Heuvelen MJ, Kempen GI, Brouwer WH, de Greef MH. Physical fitness related to disability in older persons. Gerontology. 2000;46:333–341. doi: 10.1159/000022187.
    1. Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk for malnutrition. Cochrane Database Syst Rev. 2005:CD003288.
    1. Keysor JJ, Jette AM. Have we oversold the benefit of late-life exercise? J Gerontol A Biol Sci Med Sci. 2001;56:M412–423.
    1. Keysor JJ. Does late-life physical activity or exercise prevent or minimize disablement? A critical review of the scientific evidence. Am J Prev Med. 2003;25:129–136. doi: 10.1016/S0749-3797(03)00176-4.
    1. Bean JF, Vora A, Frontera WR. Benefits of exercise forcommunity-dwelling older adults. Arch Phys Med Rehabil. 2004;85:S31–42. doi: 10.1016/j.apmr.2004.03.010. quiz S43-34.
    1. Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, van Ness PH. A prehabilitation program for the prevention of functional decline: effect on higher-level physical function. Arch Phys Med Rehabil. 2004;85:1043–1049. doi: 10.1016/j.apmr.2003.10.021.

Source: PubMed

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