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Randomized controlled trial to evaluate a prevention program for frail community-dwelling older adults: a D-SCOPE protocol.

ABSTRACT: BACKGROUND:Frail community-dwelling older adults, whom might experience problems regarding physical, cognitive, psychological, social and environmental factors, are at risk for adverse outcomes such as disability, institutionalization and mortality. People in need of help do not always find their way to care and support services and are left undetected. The aim of the D-SCOPE project is to detect frail community-dwelling older adults who previously went unnoticed and to improve their access to care and support. Goal is to increase their frailty-balance, quality of life, meaning in life, life satisfaction, mastery, community inclusion and ageing well in place. METHODS/DESIGN:The study is a prospective, longitudinal randomized four-armed controlled trial with follow-up at 6 months. The study group aims to include 900 community-dwelling older adults aged 60 years and over from 3 municipalities in Flanders (Belgium). While selecting the study group, risk profiles for frailty will be taken into account. Participants will be randomly selected from the census records in each municipality. Data will be collected prospectively at baseline (T0) and at follow-up, 6 months after baseline (T1). At baseline, participants who are at least mild frail on one of the 5 domains of frailty (CFAI-plus) or feel frail based on the subjective assessment of frailty will be randomly assigned to (1) the study group or (2) the control group. A mixed method design with the inclusion of quantitative and qualitative data analyses will be used to evaluate the efficacy and experiences of the detection and prevention program on frailty. DISCUSSION:The study will contribute to an innovative vision concerning the organization of care and support, and a timely and accurate detection and support of community-dwelling older adults at risk for frailty. TRIAL REGISTRATION:This trial was registered at ClinicalTrials.gov, on May 26, 2017, identifier: NCT03168204 .

SUBMITTER: Lambotte D

PROVIDER: S-EPMC6109979 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Randomized controlled trial to evaluate a prevention program for frail community-dwelling older adults: a D-SCOPE protocol.

Lambotte Deborah D De Donder Liesbeth L De Roeck Ellen E EE Hoeyberghs Lieve J LJ van der Vorst Anne A Duppen Daan D Van der Elst Michaël M Fret Bram B Dury Sarah S Smetcoren An-Sofie AS Kardol Martinus J M MJM Engelborghs Sebastiaan S De Deyn Peter Paul PP De Witte Nico N Schols Jos M G A JMGA Kempen Gertrudis I J M GIJM Zijlstra G A Rixt GAR De Lepeleire Jan J Schoenmakers Birgitte B Verté Dominique D Dierckx Eva E

BMC geriatrics 20180827 1

<h4>Background</h4>Frail community-dwelling older adults, whom might experience problems regarding physical, cognitive, psychological, social and environmental factors, are at risk for adverse outcomes such as disability, institutionalization and mortality. People in need of help do not always find their way to care and support services and are left undetected. The aim of the D-SCOPE project is to detect frail community-dwelling older adults who previously went unnoticed and to improve their acc ...[more]

PMID: 30149798

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Project description:BACKGROUND:Physical frailty, characterized by reduced physiologic complexity and ability to cope with stressors, is closely associated with cognitive impairment, which increases the risk of poor clinical outcomes. To better capture the association between frailty and cognitive impairment, a new construct, cognitive frailty, has been proposed. Cognitive frailty is a clinical condition characterized by the simultaneous presence of physical frailty and cognitive impairment. There is little evidence on the relationship between physical frailty and cognition, as well as cognitive frailty, in Chinese older adults. We aimed to elucidate whether physical frailty is associated with cognitive impairment in an older Chinese population. METHODS:Data were obtained from the China Comprehensive Geriatric Assessment Study. The sample comprised 3202 community-dwelling adults, aged 60 years and older, from seven Chinese cities. Physical frailty was assessed using a modified, four-item version of the Fried criteria, according to frailty phenotype. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). RESULTS:The prevalence of physical frailty, prefrailty, cognitive impairment, and cognitive frailty was 9.9, 33.9, 7.5, and 2.3%, respectively (weighted: 8.8, 33.8, 6.5, and 2.0%). The prevalence of the combination of prefrail/frail and cognitive impairment was 5.1% (weighted 4.5%). Frail participants performed worse on global cognition and all cognitive domains than robust and prefrail participants. The MMSE total score was positively correlated with walking speed and negatively correlated with age and frailty. A multivariate logistic regression revealed that after adjusting for age, gender, education level, living area, and chronic diseases, frailty, exhaustion, slowness, and inactivity were significantly associated with poor global cognition. CONCLUSIONS:The standard prevalence of physical frailty, prefrailty, cognitive impairment, and cognitive frailty in community-dwelling older adults in China was 8.8, 33.8, 6.5, and 2.0%, respectively. Frailty, exhaustion, slowness, and inactivity were significantly associated with poor global cognition.

Project description:BackgroundAs people age, the risk of becoming frail increases, often leading to negative outcomes and less well-being. Within the light of prevention, early detection and guidance to the right care and support is crucial. This study aimed to give an overview of the descriptive results of the D-SCOPE program and evaluate the process.MethodsThe D-SCOPE program was developed as a detection and prevention program for frail community-dwelling older adults. The program creates a continuum of care and support, consisting of 6 steps: (1) Targeted case-finding using risk profiles for purposeful selection, (2) Preventive home-visit by an older volunteer, (3) Home visits by a professional, (4), Warm referral, (5) Monthly follow-up and (6) Long-term follow-up by home visit. The effectiveness of this program, in terms of satisfaction and meaningfulness, was studied quantitatively by means of a randomized controlled trial amongst 869 people with a frailty risk profile and qualitatively by 15 focus groups interviews.ResultsThe quantitative study revealed that 83.9% of the participants found the different home visits within the D-SCOPE program useful. The focus group interviews shed light on several issues and advantages: a more efficient case finding due to the applied risk factors for frailty, a more intensive tailor-made care and support due to the warm referral, the importance of both small-scaled and larger interventions based on the wishes irrespective of the state of frailty of the older persons, the focus on a strengths-based instead of a deficit-based approach and the follow up as being one of the greatest strengths of the project. However, to fully understand the benefits of the program a shift in mind from intervention to prevention is necessary.ConclusionsOur quantitative data show that most participants found the home visits meaningful and were satisfied with the intervention. The qualitative findings provided more insights into the experiences of the participants with the process. Based on these insights of the 6-step model of preventive home visits, municipalities and organizations can apply this model to carry out more targeted home visits.Trial registrationThis trial was registered at ClinicalTrials.gov, on 30/05/2017, identifier: NCT03168204.

Project description:IntroductionFall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults.MethodsThis is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with community-dwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach.ResultsAll strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing 'aging' and 'fall prevention': respondents preferred to be approached differently, taking a 'life course' perspective about falls, and avoiding confronting words; and (2) 'informing about benefits' (e.g., 'living independently for longer'); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly.DiscussionThis study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing 'aging' and 'fall prevention' may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example 'staying fit and healthy', while focusing on the benefits of participating in FPPs. Gaining insight into the strategies' effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults' participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).

Dataset Information

Randomized controlled trial to evaluate a prevention program for frail community-dwelling older adults: a D-SCOPE protocol.

Publications

Randomized controlled trial to evaluate a prevention program for frail community-dwelling older adults: a D-SCOPE protocol.

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