A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial

Ian D Cameron, Nicola Fairhall, Colleen Langron, Keri Lockwood, Noeline Monaghan, Christina Aggar, Catherine Sherrington, Stephen R Lord, Susan E Kurrle, Ian D Cameron, Nicola Fairhall, Colleen Langron, Keri Lockwood, Noeline Monaghan, Christina Aggar, Catherine Sherrington, Stephen R Lord, Susan E Kurrle

Abstract

Background: Frailty is a well known and accepted term to clinicians working with older people. The study aim was to determine whether an intervention could reduce frailty and improve mobility.

Methods: We conducted a single center, randomized, controlled trial among older people who were frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, whereas the comparison group received the usual health care and support services. Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry. The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria, and mobility as assessed by the Short Physical Performance Battery. Secondary outcome measures included disability, depressive symptoms and health-related quality of life.

Results: A total of 216 participants (90%) completed the study. Overall, 68% of participants were women and the mean age was 83.3 years (standard deviation, 5.9). In the intention-to-treat analysis, the between-group difference in frailty was 14.7% at 12 months (95% confidence interval: 2.4%, 27.0%; P = 0.02). The score on the Short Physical Performance Battery, in which higher scores indicate better physical status, was stable in the intervention group and had declined in the control group; with the mean difference between groups being 1.44 (95% confidence interval, 0.80, 2.07; P <0.001) at 12 months. There were no major differences between the groups with respect to secondary outcomes. The few adverse events that occurred were exercise-associated musculoskeletal symptoms.

Conclusions: Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program.

Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000250336.

Figures

Figure 1
Figure 1
Eligibility, randomization and follow-up.

References

    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–156. doi: 10.1093/gerona/56.3.M146.
    1. Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med. 2010;26:275–286. doi: 10.1016/j.cger.2010.02.002.
    1. Espinoza S, Walston JD. Frailty in older adults: insights and interventions. Cleve Clin J Med. 2005;72:1105–1112. doi: 10.3949/ccjm.72.12.1105.
    1. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323–336.
    1. Pel-Littel RE, Schuurmans MJ, Emmelot-Vonk MH, Verhaar HJ. Frailty: defining and measuring of a concept. J Nutr Health Aging. 2009;13:390–394. doi: 10.1007/s12603-009-0051-8.
    1. Theou I, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA, Jones GR. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res. 2011;2011:569194.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94. doi: 10.1093/geronj/49.2.M85.
    1. Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, Monaghan N, Cameron ID. Frailty Intervention Trial (FIT) BMC Geriatr. 2008;8:27. doi: 10.1186/1471-2318-8-27.
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Holtzman J, Lurie N. Causes of increasing mortality in a nursing home population. J Am Geriatr Soc. 1996;44:258–264.
    1. Stuck AE, Siu AL, Weiland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342:1032–1036. doi: 10.1016/0140-6736(93)92884-V.
    1. Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Aggar C, Monaghan N, Gill L, Cameron ID. Treating frailty - a practical guide. BMC Med. 2011;9:83. doi: 10.1186/1741-7015-9-83.
    1. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17:37–49. doi: 10.1016/0022-3956(82)90033-4.
    1. Weight Bearing Exercise for Better Balance.
    1. Onder G, Penninx BW, Lapuerta P, Fried LP, Ostir GV, Guralnik JM, Pahor M. Change in physical performance over time in older women: the Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci. 2002;57:M289–293. doi: 10.1093/gerona/57.5.M289.
    1. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–343. doi: 10.3109/07853890109002087.
    1. Latham NK, Anderson CS, Lee A, Bennett DA, Moseley A, Cameron ID. Fitness Collaborative Group. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS) J Am Geriatr Soc. 2003;51:291–299. doi: 10.1046/j.1532-5415.2003.51101.x.
    1. Fairhall N, Sherrington C, Kurrle SE, Lord SR, Lockwood K, Cameron ID. Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. BMC Medicine. 2012;10:120. doi: 10.1186/1741-7015-10-120.
    1. Pocock SJ, Abdalla M. The hope and hazards of using compliance data in randomized controlled trials. Stat Med. 1998;17:303–317. doi: 10.1002/(SICI)1097-0258(19980215)17:3<303::AID-SIM764>;2-0.
    1. Kerse N, Hayman KJ, Moyes SA, Peri K, Robinson E, Dowell A, Kolt GS, Elley CR, Hatcher S, Kiata L, Wiles J, Keeling S, Parsons J, Arroll B. Home-based activity program for older people with depressive symptoms: DeLLITE-a randomized controlled trial. Ann Fam Med. 2010;8:214–223. doi: 10.1370/afm.1093.
    1. Hall CJ, Peel NM, Comans TA, Gray LC, Scuffham PA. Can post-acute care programmes for older people reduce overall costs in the health system? A case study using the Australian Transition Care Programme. Health Soc Care Community. 2011;20:97–102.

Source: PubMed

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