A Clinimetric Evaluation of Specialized Geriatric Care for Rural Dwelling, Frail Older People

Abstract

A MGAT can target rural dwelling, frail older persons, perform in-home CGA, and develop an intervention strategy. Although the intervention did not prolong life or delay institutionalization, clinically important benefits were observed.

Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review

“…The mean age of all participants was 79 years, and 69% of the participants were women (supplementary materials/appendix 1). The methodological quality of included trials varied; seven trials (Hall et al 1992;Leveille et al 1998;Mann et al 1999;Dalby et al 2000;Rockwood et al 2000;Chin et al 2001;Phelan et al 2004;Holland et al 2005) were of low quality according to the criteria (van Tulder et al 2003), and seven trials were of high quality (Dalby et al 2000;Stuck et al 2000;van Haastregt et al 2000;Hebert et al 2001;Gill et al 2002Gill et al , 2004Gitlin et al 2006a;b;Markle-Reid et al 2006) ( Table 1).…”

“…Finally, a total of 19 articles (Hall et al 1992;Leveille et al 1998;Mann et al 1999;Dalby et al 2000;Rockwood et al 2000;Stuck et al 2000;van Haastregt et al 2000;Chin et al 2001;Hebert et al 2001;Chin et al 2002;Gill et al 2002Gill et al , 2004Phelan et al 2004;Holland et al 2005;Gitlin et al 2006a;b;Markle-Reid et al 2006;Bouman et al 2008a, b), all RCTs concerning communitydwelling persons 65 years or older identified as frail, vulnerable, at risk of functional decline, having disabilities or chronic conditions and receiving multi-component HPDP interventions were included for detailed review (Fig. 1).…”

“…Subsequently, the concept of frailty was operationalised as the elderly person being inactive in combination with involuntary weight loss or low body mass index (BMI) (Chin et al 2001(Chin et al , 2002, alternatively having at least one (Leveille et al 1998;Chin et al 2001Chin et al , 2002Phelan et al 2004;Holland et al 2005) or three chronic conditions (Stuck et al 2000). Others considered an older person to be frail based on the existence of multiple medical problems (Rockwood et al 2000) or unspecified functional impairments (Dalby et al 2000;Rockwood et al 2000). Two trials included impaired cognitive functions in the concept of frailty (Hall et al 1992;Rockwood et al 2000), and one of them specified dementia as a common condition among frail older people (Rockwood et al 2000).…”

“…Others considered an older person to be frail based on the existence of multiple medical problems (Rockwood et al 2000) or unspecified functional impairments (Dalby et al 2000;Rockwood et al 2000). Two trials included impaired cognitive functions in the concept of frailty (Hall et al 1992;Rockwood et al 2000), and one of them specified dementia as a common condition among frail older people (Rockwood et al 2000). In contrast, a number of articles stated that included participants should not be cognitively impaired (Mann et al 1999;Holland et al 2005;Gitlin et al 2006a, b), or should be without dementia (Leveille et al 1998;Gill et al 2002Gill et al , 2004Phelan et al 2004).…”

“…The concept of frailty can be expanded by accumulating functional decline or disability, including activity limitations and participation restrictions (Hall et al 1992;Mann et al 1999;Dalby et al 2000;Rockwood et al 2000;Chin et al 2001;Hebert et al 2001;Chin et al 2002;Gill et al 2002Gill et al , 2004Markle-Reid et al 2006). As a corollary, physically frail older people are considered to present high rates of impairments, activity limitations and participation restrictions (Gill et al 2004), which in a deterministic way produce loss of autonomy (Hebert et al 2001).…”