Self‐Reported Hearing Impairment and Incident Frailty in English Community‐Dwelling Older Adults: A 4‐Year Follow‐Up Study

Liljas, Ann; Carvalho, Lívia A.; Papachristou, Efstathios; Oliveira, César de; Wannamethee, SG; Ramsay, Sheena E; Walters, Kate

doi:10.1111/jgs.14687

Cited by 67 publications

(99 citation statements)

References 47 publications

(113 reference statements)

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“…Table 13 shows the Fried frailty phenotype 10 of participants at baseline. Although all participants met the criteria for 'mild frailty' at baseline, using the Fried phenotype 21 and applying cut-off points for the bottom quintile of grip strength and gait speed from the English Longitudinal Study of Ageing (own data), 225,255 we found that just over of half the sample were frail and only 43% were 'pre-frail'. This was largely explained by poor grip strength, low physical activity and low energy levels in the sample.…”

Section: Feasibility Randomised Controlled Trial: Resultsmentioning

confidence: 99%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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Background Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting Community settings in London and Hertfordshire, UK. Participants A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work A large, definitive RCT of the HomeHealth service is warranted. Study registration This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

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Section: Feasibility Randomised Controlled Trial: Resultsmentioning

confidence: 99%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

Self Cite

View full text Add to dashboard Cite

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“…Our findings are, however, consistent with previous research on the subfactors that were included in our analysis. Several longitudinal studies have shown strong predictive validity of cognitive (namely memory and executive function),47 48 locomotor (gait or chair rise),49–51 sensory (vision and hearing),23 52–54 vitality (hand grip strength or FEV),55–58 and psychological59 indicators in relation to incident loss of ADL and IADL. Studies have also demonstrated associations between indicators of intrinsic capacity and survival.…”

Section: Discussionmentioning

confidence: 99%

“…Sensory: Hearing and vision impairments were measured using self-reported,22 23 validated questions previously demonstrated to be accurate when compared with objective measures. Hearing status was assessed by asking participants to rate their hearing (using a hearing aid if they used one) as excellent, very good, good, fair, or poor.…”

Section: Methodsmentioning

confidence: 99%

The structure and predictive value of intrinsic capacity in a longitudinal study of ageing

et al. 2019

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ObjectivesTo assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.DesignStructural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.SettingsCommunity, United Kingdom.Participants2560 eligible participants aged over 60 years.Main outcome measuresActivities of daily living (ADL) and instrumental activities of daily living (IADL).ResultsOne general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.ConclusionsThe WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.

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“…However, use of this questionnaire to assess the association of frailty with QoL is still scarce, limiting direct comparisons with studies in other settings. Older age, poor financial situation, poor social support, multimorbidity, chronic pain, cognitive impairment, and hearing and vision impairment are associated with both frailty and lower QoL scores [47][48][49][50][51][52][53][54][55][56][57][58]. We therefore adjusted our final regression model for all these variables to estimate the independent association of frailty with QoL.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The association between frailty and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka: a cross-sectional study

et al. 2019

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The objective of this study was to estimate the cross-sectional association of frailty with overall and domain-specific quality of life (QoL) in rural community-dwelling older adults in Kegalle district of Sri Lanka. Methods A population-based cross-sectional study was conducted with 746 community-dwelling older adults aged ≥60 years living in the rural areas of Kegalle district of Sri Lanka in 2016. A three-stage probability sampling design was used to recruit participants. Frailty and QoL were assessed using the Fried phenotype and Older People's Quality of Life Questionnaire respectively. Multivariable linear regression was used to estimate the association of frailty with QoL after accounting for the complex sampling design. Results The median (IQR) age of the sample was 68 (64: 75) years and comprised of 56.7% women. 15.2% (95% CI: 12.4%, 18.7%) were frail and 48.5% (95% CI: 43.9%, 53.2%) were pre-frail. The unadjusted means (SE) of the total QoL score for the robust, pre-frail and frail groups were 139.2 (0.64), 131.8 (1.04) and 119.2 (1.35) respectively. After adjusting for covariates in the final multivariable model, the estimated difference in mean QoL were lower for both frail and pre-frail groups versus robust. The estimated reduction in the total QoL score was 7.3% for those frail and 2.1% for those pre-frail. All QoL domains apart from 'social relationships and participation', 'home and neighbourhood' and 'financial circumstances' were associated with frailty. Conclusions Frailty was associated with a small but significant lower quality of life in this rural Sri Lankan population, which appears largely explained by 'health' and 'independence, control 3 over life and freedom' QoL domains. Interventions aiming to improve quality of life in frail older adults should consider targeting these aspects.

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Self‐Reported Hearing Impairment and Incident Frailty in English Community‐Dwelling Older Adults: A 4‐Year Follow‐Up Study

Cited by 67 publications

References 47 publications

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

The structure and predictive value of intrinsic capacity in a longitudinal study of ageing

The association between frailty and quality of life among rural community-dwelling older adults in Kegalle district of Sri Lanka: a cross-sectional study

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