Testing the effectiveness of a multicomponent frailty management program in Singapore

The study will be a three-arm cluster-randomised trial to evaluate the cost-effectiveness of the multi-component frailty management program over 12 months. Each participating centre will be randomly assigned to intervention A, B or C using a computer-generated list. Centres with intervention A will conduct the frailty management program led by an Allied Health Professional (AHP). Centres with intervention B will conduct the Frailty management program led by a non-AHP. Centres with intervention C will carry on with usual care without additional intervention. The programme (intervention A &B) consists of 12 weekly group sessions facilitated by a trained program leader (AHP or non-AHP). This is followed by a one-month booster session and a 3-month phone call as part of the follow-up. Group size: 10-12 participants The mode of delivery: It is a group-based intervention. Upon program commencement, the program leader facilitates each participant in a small group setting (group size 10-12) to set personal goals that will be reviewed after the completion of the 12-week intervention. The weekly sessions involve a 1-hour talk by healthcare professionals like dietitians, occupational therapists, physiotherapists (or exercise trainers), and pharmacists, covering different topics such as frailty and risk assessment, common chronic health conditions, fall prevention strategies, healthy lifestyle tips (including healthy diet), strategies for community independent living and safe community mobility practice. Next is a 15-minute break to encourage social networking between participants, followed by 45 minutes of low-to-moderate intensity balance and strength exercises. At the beginning of each session, the program leader checks the weekly homework consisting of strength and balance exercises and different content topics. Throughout the 3-month intervention, the program leader calls absent participants to update them on the missed content. Balance and strength exercises are adapted from Otago Exercise Program and ViviFrail.com. The chosen exercises (e.g.e.g. arm strengthening exercises with theraband, leg and calf raises, reverse knee bend, side hip strengthening, partial squat, sit-to-stand, single leg stand, tandem walking) are considered as low intensity, which will be upgraded to a moderate level for some individuals who are progressing. Exercises will be checked by the exercise specialist (PT or fitness instructor) at the later session Materials used during the program: - blood pressure monitor, therabands, walking aids, fall prevention probs (e.g. anti-slip solutions, unsafe shoes), - healthy eating brochure (https://www.healthhub.sg/sites/assets/Assets/Programs/my-healthy-plate/pdfs/My_Healthy_Plate_Fact_Sheet_-_Updated_4May_2021.pdf) - fall prevention brochure (https://www.healthhub.sg/sites/assets/Assets/PDFs/HPB/Falls%20Prevention/Falls%20Prevention%20Guidebook_English.pdf) - weekly program handouts and homework sheets. Strategies used to assess or monitor participants’ compliance to the intervention: - Weekly homework will be checked by the program facilitator; - Weekly attendance will be recorded. The programme also includes a 2-hour booster session at one-month post-intervention. In this session, the program facilitator will review the key learning points from the program. They will do all strength and balance exercises as part of the review, and discuss their coping strategies implemented and any new goal achievements in the past month. Resources and advice will be provided to participants who had challenges in strategy implementation and coping at home. During the three-month follow-up, the program facilitator will make a 10-15-minute phone call to each participant to find out his/her strategy implementation and any goal achievements in the past two months. All participants will be encouraged to continue reading the program booklet and attending community-based programs (e.g. fitness programs, social programs) to keep them healthy and active. About program leaders The Say No To Frailty program is led/facilitated by a trained program leader. The program leader is someone who has a strong interest and a minimum of 2 years of experience working with older adults living in the community. Any allied health professionals (e.g. physiotherapists, occupational therapists, social workers, nurses, dietitians) or non-allied health professionals (e.g. fitness instructors, exercise trainers, care coordinators) must complete a 3-day program leader training workshop as pre-requisition before starting the Say No To Frailty program.