A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial

BMC Medicine

Susan E Kurrle⁵  Stephen R Lord³  Catherine Sherrington²  Christina Aggar⁴  Noeline Monaghan¹  Keri Lockwood¹  Colleen Langron⁵  Nicola Fairhall²  Ian D Cameron¹ 

[1] Rehabilitation Studies Unit, University of Sydney, PO Box 6, Ryde NSW 1680, Australia;George Institute for Global Health, University of Sydney, PO Box M201 Missenden Road, Sydney NSW 2050, Australia;Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, PO Box 1165, Randwick NSW 2031, Australia;Faculty of Nursing and Midwifery, University of Sydney, Camperdown NSW 2006, Australia;Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Palmerston Road, Hornsby NSW 2077, Australia

关键词: walking;    therapeutics;    randomized controlled trial;    frail elderly;    activities of daily living;   

Others  :  857153
DOI  :  10.1186/1741-7015-11-65

 received in 2012-07-02, accepted in 2013-03-11,  发布年份 2013

【 摘 要 】

Background

Frailty is a well known and accepted term to clinicians working with older people. The study aim was to determine whether an intervention could reduce frailty and improve mobility.

Methods

We conducted a single center, randomized, controlled trial among older people who were frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, whereas the comparison group received the usual health care and support services. Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry. The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria, and mobility as assessed by the Short Physical Performance Battery. Secondary outcome measures included disability, depressive symptoms and health-related quality of life.

Results

A total of 216 participants (90%) completed the study. Overall, 68% of participants were women and the mean age was 83.3 years (standard deviation, 5.9). In the intention-to-treat analysis, the between-group difference in frailty was 14.7% at 12 months (95% confidence interval: 2.4%, 27.0%; P = 0.02). The score on the Short Physical Performance Battery, in which higher scores indicate better physical status, was stable in the intervention group and had declined in the control group; with the mean difference between groups being 1.44 (95% confidence interval, 0.80, 2.07; P <0.001) at 12 months. There were no major differences between the groups with respect to secondary outcomes. The few adverse events that occurred were exercise-associated musculoskeletal symptoms.

Conclusions

Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program.

Trial registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000250336

【 授权许可】

   
2013 Cameron et al; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56:M146-156.
• [2]Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B: The assessment of frailty in older adults. Clin Geriatr Med 2010, 26:275-286.
• [3]Espinoza S, Walston JD: Frailty in older adults: insights and interventions. Cleve Clin J Med 2005, 72:1105-1112.
• [4]Mitnitski AB, Mogilner AJ, Rockwood K: Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 2001, 1:323-336.
• [5]Pel-Littel RE, Schuurmans MJ, Emmelot-Vonk MH, Verhaar HJ: Frailty: defining and measuring of a concept. J Nutr Health Aging 2009, 13:390-394.
• [6]Theou I, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA, Jones GR: The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res 2011, 2011:569194.
• [7]Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49:M85-94.
• [8]Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, Monaghan N, Cameron ID: Frailty Intervention Trial (FIT). BMC Geriatr 2008, 8:27. BioMed Central Full Text
• [9]Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12:189-198.
• [10]Holtzman J, Lurie N: Causes of increasing mortality in a nursing home population. J Am Geriatr Soc 1996, 44:258-264.
• [11]Stuck AE, Siu AL, Weiland GD, Adams J, Rubenstein LZ: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993, 342:1032-1036.
• [12]Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Aggar C, Monaghan N, Gill L, Cameron ID: Treating frailty - a practical guide. BMC Med 2011, 9:83. BioMed Central Full Text
• [13]Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982, 17:37-49.
• [14]Weight Bearing Exercise for Better Balance [http://www.webb.org.au] webcite
• [15]Onder G, Penninx BW, Lapuerta P, Fried LP, Ostir GV, Guralnik JM, Pahor M: Change in physical performance over time in older women: the Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci 2002, 57:M289-293.
• [16]Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 1965, 14:61-65.
• [17]Rabin R, de Charro F: EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001, 33:337-343.
• [18]Latham NK, Anderson CS, Lee A, Bennett DA, Moseley A, Cameron ID, Fitness Collaborative Group: A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc 2003, 51:291-299.
• [19]Fairhall N, Sherrington C, Kurrle SE, Lord SR, Lockwood K, Cameron ID: Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. BMC Medicine 2012, 10:120. BioMed Central Full Text
• [20]Pocock SJ, Abdalla M: The hope and hazards of using compliance data in randomized controlled trials. Stat Med 1998, 17:303-317.
• [21]Kerse N, Hayman KJ, Moyes SA, Peri K, Robinson E, Dowell A, Kolt GS, Elley CR, Hatcher S, Kiata L, Wiles J, Keeling S, Parsons J, Arroll B: Home-based activity program for older people with depressive symptoms: DeLLITE-a randomized controlled trial. Ann Fam Med 2010, 8:214-223.
• [22]Hall CJ, Peel NM, Comans TA, Gray LC, Scuffham PA: Can post-acute care programmes for older people reduce overall costs in the health system? A case study using the Australian Transition Care Programme. Health Soc Care Community 2011, 20:97-102.