Home Modification and Prevention of Frailty Progression in Older Adults: A Japanese Prospective Cohort Study

Abstract

The aim of this study was to determine whether home modification was associated with subsequent progression of frailty and mortality in older adults. We conducted a prospective cohort study in 574 adults 65 and older who required a low or moderate level of care. Of these, 34% modified their homes-most frequently a corridor-and the most common type of modification was the installation of handrails. The mortality was significantly lower among older adults with home modifications than in those without home modifications at 2 years (adjusted hazard ratio [HR] = 0.52; 95% confidence interval [CI] [0.32, 0.87]), 3 years (HR = 0.57, 95% CI [0.54, 0.81]), and 4.7 years (HR = 0.65, 95% CI [0.65, 0.91]). These findings suggest that home modification may prevent the progression of frailty (i.e., need for low/moderate level of care increasing to the need for high level of care) in older adults.

Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies

“…The mean Edmonton frail score was 8.6 (SD 2.4) for the IG and 8.5 (SD 1.9) for the CGThe frailty score significantly improved in the IG ( P < 0.001), 31.4% had a reversal of frailty and none in the CG. Similarly, the Edmonton Frail scale also significantly improved (mean frailty score after IG 7.7 and 9.3 for CG)Mitoku 2014 [25]Frailty = a change in of care levelUnclearThe results were NSYamada 2012 [24]Frailty score >10 on the frailty checklistCG frailty checklist pre score 7.3 and IG 7.4The total score for exercise group after intervention was 7.1 SD 4.0 and control 8.0 SD 4.8 P < 0.001. During the year, 8% of intervention and 18% in the CG were newly certified for LTCI (considered frail) P < 0.05

VO 2 max, maximum volume of oxygen consumption; FM, frailty marker; CCSHA_CFS-TV, Chinese Canadian Study of Health and Aging Clinical Frailty Scale Telephone Version; CHS_PCF, cardiovascular health Study Phenotypic Classification of Frailty; EN, Exercise and Nutrition; CES-D, Center for Epidemiological Studies Depression scale; EX+MFGM, exercise and milk fat globule membrane; Ex, Exercise; NS, not significant; P , P -value; HR, hazard ratio.

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“…One hundred and nine articles were selected for full text review and 14 studies were included in this review. Twelve studies were randomised controlled trials (RCTs) [13–23] and two studies were part of larger cohort studies [24, 25] (see Supplementary data, Tables A and B, available at Age and Ageing online). Seven studies were conducted in Asia [5, 17–19, 21, 24, 25], 3 in Europe [16, 20, 23], 3 in USA [13–15] and 1 in Australia [22].…”

“…The quality was moderate to good for most studies. The response rate was not reported for the two cohort studies [24, 25] and for the RCTs it varied between 39% [18] and 100% [20]. The randomisation, allocation concealment and the level of blinding were not always described [5, 14, 16, 20, 21].…”

“…The frailty definitions used are listed in Table 1 and most studies used the Cardiovascular Health Study frailty phenotype (also known as Fried's phenotype) (10 studies) [5, 13, 16–23], the Tinetti/Gill criteria (2 studies) [14, 15] or the Japanese Frailty checklist (2 studies) [24, 25]. …”

“…showed a significant reduction in the prevalence of frailty and the total number of frailty markers [22]. Mitoku showed non-significant results of home modifications on frailty prevalence [25]. …”