Effectiveness and usability of the system for assessment and intervention of frailty for community-dwelling pre-frail older adults: A pilot study

Abstract

BackgroundEffective multicomponent interventions in the community targeted at preventing frailty in at-risk older adults can promote healthy ageing. However, there is a lack of studies exploring the effectiveness of technology-enabled autonomous multi-domain community-based interventions for frailty. We developed a novel end-to-end System for Assessment and Intervention of Frailty (SAIF) with exercise, nutrition, and polypharmacy components. This pilot study aimed to explore SAIF’s effectiveness in improving frailty status, physical performance and strength, and its usability in pre-frail older adults.Materials and methodsThis is a single arm 8-week pilot study in 20 community-dwelling older adults who were pre-frail, defined using the Clinical Frailty Scale (CFS) as CFS 3 + (CFS 3 and FRAIL positive) or CFS 4. For outcomes, we assessed frailty status using the modified Fried Frailty Phenotype (FFP) and CFS; physical performance using Short Physical Performance Battery (SPPB); and Hand Grip Strength (HGS) at baseline and 8-week. User experience was explored using the System Usability Scale (SUS), interest-enjoyment subscale of the Intrinsic Motivation Inventory and open-ended questions. We analyzed effectiveness using repeated-measures tests on pre-post scores, and usability using a convergent mixed-method approach via thematic analysis of open-ended responses and descriptive statistics of usability/interest-enjoyment scales.ResultsSixteen participants (71.8 ± 5.5 years) completed the 8-week study. There was a significant improvement in FFP score (−0.5, p < 0.05, effect size, r = 0.43), but not CFS (−1.0, p = 0.10, r = 0.29). Five (31.3%) improved in frailty status for both FFP and CFS. SPPB (+1.0, p < 0.05, r = 0.42) and HGS (+3.5, p < 0.05, r = 0.45) showed significant improvements. Three themes were identified: “Difficulty in module navigation” (barriers for SAIF interaction); “User engagement by gamification” (facilitators that encourage participation); and “Perceived benefits to physical health” (subjective improvements in physical well-being), which corroborated with SUS (68/100) and interest-enjoyment (3.9/5.0) scores. Taken together, user experience results cohere with the Senior Technology Acceptance and Adoption Model.ConclusionOur pilot study provides preliminary evidence of the effectiveness of SAIF in improving frailty status, physical performance and strength of pre-frail older adults, and offers user experience insights to plan the follow-up large-scale randomized controlled trial.

The Co-Design/Co-Development and Evaluation of an Online Frailty Check Application for Older Adults: Participatory Action Research with Older Adults

“…In this study, we found that the average scores of SUS for the online FC application are 70.2 ± 10.3, which indicated a marginally high rate of acceptability. Consistently, it was demonstrated that SUS scores of community-dwelling older adults (70.9 ± 5.6 years) were 68 in a recent pilot study for the system for assessment and intervention of frailty [ 45 ]. Although the SUS is a standardized questionnaire designed to assess perceived usability [ 36 ], there is a lack of studies exploring the usability of technology, especially for older adults.…”

Facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia: A qualitative meta-synthesis

“…Community support encompasses different levels of family, community, and government with manifest and potential support. We found that partners and health care professionals play an important role in providing social support by providing thorough supervision [ 37 , 44 , 52 ], timely feedback and emotional support, which is conducive to helping older adults improve self-efficacy and adhere to beneficial dietary recommendations [ 38 , 43 , 55 ]. The high cost of healthy foods or nutritional preparations is a common barrier to adherence to recommended diets among older adults, and this cost can easily undermine persistence to recommended diets due to the absence of continued support after the intervention [ 56 ].…”

“…Studies have shown that dietary protein intake after resistance exercise increases postexercise muscle protein synthesis rates and inhibits muscle protein catabolism [ [65] , [66] , [67] ], which is important for promoting muscle health in older adults. Interestingly, previous studies have considered the facilitating role of specialists (e.g., dietitians or general practitioners) in guiding patients to healthy diets [ [36] , [37] , [38] , [39] , [40] , [42] , [43] , [44] , [45] , 55 ], but we found that some “specialists” could be a barrier to intervention implementation for not being able to give adequate and effective guidance promptly if they lacked sufficient competence, played weak roles or the intervention stopped abruptly. This is particularly pronounced in primary care settings where healthcare resources are relatively scarce [ 38 , 39 , 68 ], which puts higher demands on the adequacy, professionalism and timeliness of interventionists.…”