Wider implementation of the frailty management program “Say No To Frailty” in Singapore

Older adult participants will receive the Say No To Frailty program led by a trained healthcare professional, such as physiotherapist, occupational therapist, dietitian, medical social worker, and pharmacist. The “Say no to frailty” program is a multicomponent group intervention designed for community-living older adults with signs of frailty and pre-frailty. It consists of 12 weekly sessions facilitated by trained program facilitators followed by a booster session and phone calls at 1-month and 3-month post-intervention respectively. The program uses adult learning principles to allow individuals in a small group (n=12) to learn the right exercises and strategies for managing different risk factors at their own pace and be responsible for their health. The aim is to facilitate their behavioural changes through personalized goal setting leading to a healthy lifestyle and age in place. The duration of each session: 2 hours/session Main languages used during the intervention: English and/or Mandarin The following contents will be covered throughout the 12-week intervention: - Understanding frailty and risk assessment - Personalised goal setting - Understanding common chronic health conditions and causes - Fall prevention strategies - Healthy lifestyle tips (including healthy eating) - Strategies for community independent living - Community mobility practice - Weekly balance and strength exercises: all exercises are adapted from Otago Exercise Program and ViviFrail.com. The chosen exercises are considered as low intensity, which will be taught by the invited exercise specialist (PT or fitness instructor) in the first two sessions. Example of strength exercises include: arm opening with resistance band, elbow flexion with resistance band, opening arm diagonally with resistance band, reverse knee flexion, heel raises, hip abduction and knee raises. Example of balance exercises include: sit-to-stand, single-leg stand, tandem stand and tandem walk. The exercises will be upgraded to a moderate level for some individuals who are progressing and checked by the exercise specialist at the later session. Each participant will be reviewed in each weekly session by the trained program facilitator, and whenever participants find the exercises too easy, these exercises will be upgraded (e.g. adding an extra ankle weight or exercise band, increasing the number of repetitions; reducing the base of support) to make it more challenging. Each participant will be prescribed with weekly homework. For instance, participants are recommended to complete the prescribed strength and balance exercises three times a week using the issued exercise worksheets. Together with other content-related homework (e.g. home safety checklist, daily food diary, community safety hazards, medication log sheet, etc) will be issued to each participant and checked by the program facilitator in the following week. In the event when some participants do not complete the prescribed homework, the program facilitator will find out the barriers and seek inputs from other participants through group discussion. Session attendance, together with the above weekly homework sheets, will be used to monitor adherence to the intervention. Materials will be used during the program: - blood pressure monitor, resistance bands, walking aids, fall prevention probs (e.g. anti-slip solutions, unsafe shoes), healthy eating brochure, fall prevention brochure, weekly program handouts and homework sheets. The programme also includes a 2-hour booster session one-month post-intervention. In this session, the program facilitator will review the key learning points from the program. The participants will do all balance and strength exercises as part of the review, 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 post-intervention follow-up, the program facilitator will make a 10-15 minutes 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 the program facilitator: The Say No To Frailty program will be led by a trained program facilitator who is someone who has a strong interest and a minimum of 1 year of experience working with older adults living in the community. Eligible allied health professionals (e.g. physiotherapists, occupational therapists, social workers, dietitians) or non-allied health professionals (e.g. fitness instructors, exercise trainers, care coordinators, volunteers) working in the participating organizations will complete a 2-day program facilitator training workshop 3 months before starting the Say No To Frailty program. The program facilitator training workshop will be conducted by the PI (Xu) who is a master trainer with more than 20 years of clinical experience in this field. The workshop content includes theoretical frameworks (e.g. adult learning principles), program content, exercise training and facilitation skills through role-play. Each program facilitator will be assessed for competency before being issued with a completion certificate.