Effects of a Primary Care-Based Multifactorial Intervention on Physical and Cognitive Function in Frail, Elderly Individuals: A Randomized Controlled Trial

Romera-Liebana, Laura; Orfila, Francesc; Segura, Josep M; Real, Jordi; Fabra, Maria Lluïsa; Möller, Mercedes; Lancho, Santiago Lancho; Ramírez, A. Susana; Martí, Núria; Cullell, Montserrat; Bastida, Nuria; Martinez, Dolors; Giné, Maria; Cendrós, Patricia; Bistuer, Anna; Pérez, Elena; Fabregat, Maria Assumpta; Foz, Gonçal

doi:10.1093/gerona/glx259

Cited by 74 publications

(120 citation statements)

References 42 publications

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“…Lastly, several recent publications have reported successful results of multifactorial, multidisciplinary approaches simultaneously targeting physical activity, nutrition, polypharmacy, depression, cognitive function, and other factors. [60][61][62][63][64] These studies were beyond the scope of our meta-analysis due to the highly diverse components in each intervention, but this holistic approach certainly warrants further attention by researchers.…”

Section: Suggestions For Further Researchmentioning

confidence: 99%

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

et al. 2020

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IntroductionThe best interventions to address frailty among older adults have not yet been fully defined, and the diversity of interventions and outcome measures makes this process challenging. Consequently, there is a lack of guidance for clinicians and researchers regarding which interventions are most likely to help older persons remain robust and independent. This paper uses meta-analysis to assess effectiveness of primary care interventions for physical frailty among community-dwelling adults aged 60+ and provides an up-to-date synthesis of literature in this area. MethodsPubMed, CINAHL, Cochrane Register of Controlled Trials, and PEDro databases were searched, and RCTs, controlled pilot studies, or trials with similar study designs addressing frailty in the primary care setting among persons aged 60+ were chosen. Study data was abstracted following PRISMA guidelines, then meta-analysis was performed using the random effects model. OPEN ACCESS Citation: Macdonald SH-F, Travers J, Shé ÉN, Bailey J, Romero-Ortuno R, Keyes M, et al. (2020) Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis. PLoS ONE 15(2): e0228821. https://doi.org/10.1371/journal.

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Section: Suggestions For Further Researchmentioning

confidence: 99%

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

et al. 2020

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“…Cognitive training strategies and comprehensive geriatric assessment with interdisciplinary interventions address important non‐physical health domains. More recently, researchers have reported benefits from multifactorial interventions incorporating exercise, a nutritional intervention, and cognitive training with social support or medication review …”

Section: Frailty Interventionsmentioning

confidence: 99%

“…More recently, researchers have reported benefits from multifactorial interventions incorporating exercise, a nutritional intervention, and cognitive training with social support 40 or medication review. 41 Criticisms of the available frailty interventions include imperfect treatment compliance, variable durability of effects post-intervention and cost-effectiveness. While provisional results regarding these issues are reassuring, 36,41,42 further investigation is justified considering the complexity of the interventions and the vast number of potential recipients.…”

Section: Frailty Interventionsmentioning

confidence: 99%

Differences in frailty in older men and women

Gordon

Hubbard

2019

Medical Journal of Australia

119

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Summary Frailty describes an individual's vulnerability to adverse health outcomes and is a useful construct that assists health professionals to understand the heterogeneity of the ageing population. While the pathophysiological pathways that lead to frailty are not well defined, an individual's sex appears to be a key factor influencing the ageing trajectory. Compared with age‐matched men, women tend to have poorer health status (ie, they are more frail) but longer life expectancy (ie, they are more resilient). It seems likely that a combination of biological, behavioural and social factors underpin this male–female health–survival paradox. Randomised controlled trial data for frailty interventions in older adults are emerging, with multicomponent programs incorporating exercise and nutrition‐based strategies showing promise. Pharmaceutical and other innovative therapeutic strategies for frailty are highly anticipated. Sex differences in the effectiveness of frailty interventions have not been addressed in the research literature to date. In the future, successful interventions may target many (if not all) biopsychosocial domains, with careful consideration of issues relevant to each sex.

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“…Due to the relevance of mobility and instrumental activities of daily living in the prediction of adverse outcomes, community interventions based on physical and functional exercises should be prioritised to improve/maintain independence and quality of life in older adults [69,70].…”

Section: Recommendationsmentioning

confidence: 99%

The Impact of Frailty on Admission to Home Care Services and Nursing Homes: Eight-Year Follow-Up of a Community-Dwelling, Older Adult, Spanish Cohort

Cegri

Orfila

Abellana

et al. 2020

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BackgroundFrailty in older adults is a common multidimensional clinical entity, a state of vulnerability to stressors that increases the risk of adverse outcomes such as functional decline, institutionalization or death. The aim of this study is to identify the factors that anticipate the future inclusion of community-dwelling individuals aged ≥70 years in home care programmes (HC) and nursing homes (NH), and to develop the corresponding prediction models. MethodsA prospective cohort study was conducted in 23 primary healthcare centers located in Catalonia, Spain, with an eight-year follow-up (2005-2013). The cohort was made up of 616 individuals. Data collection included a baseline multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic healthcare records, and the Central Registry of Catalonia for mortality. A prognostic index for a HC and NH at eight years was estimated for each patient. Death prior to these events was considered a competing risk event, and Fine–Gray regression models were used. Results At baseline, mean age was 76.4 years and 55.5% were women. During follow-up, 19.2% entered a HC program, 8.2% a NH, and 15.4% died without presenting an event. Of those who entered a NH, 31.5% had previously been in a HC program. Multivariate models for a HC and NH showed that the risk of a HC entry was associated with older age, dependence on the Instrumental Activities of Daily Living, and slow gait measured by Timed-up-and-go test. An increased risk of being admitted to a NH was associated with older age, dependence on the Instrumental Activities of Daily Living, number of prescriptions, and the presence of social risk.ConclusionsPrognostic models based on comprehensive geriatric assessments can predict the need for the commencement of HC and NH admission in community-dwelling older adults. Our findings underline the necessity to measure functional capacity, mobility, number of prescriptions, and social aspects of older adults in primary healthcare centers. In such a setting they can be offered longitudinal holistic assessments so as to benefit from preventive actions in order to remain independent in the community for as long as possible.

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Effects of a Primary Care-Based Multifactorial Intervention on Physical and Cognitive Function in Frail, Elderly Individuals: A Randomized Controlled Trial

Cited by 74 publications

References 42 publications

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

Differences in frailty in older men and women

The Impact of Frailty on Admission to Home Care Services and Nursing Homes: Eight-Year Follow-Up of a Community-Dwelling, Older Adult, Spanish Cohort

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