Frail Elderly Persons
Conditions
Keywords
Frailty, health promotion, prevention, self management, intervention
Brief summary
The present study Elderly person in the risk zone form part of the research programme Support for frail elderly persons - from prevention to palliation (www. Vardalinstitutet.net) which comprises research into three interventions. A fundamental principle in the research programme is that it comprises interventions addressing frail elderly person in different phases of the disablement process, from elderly persons who are beginning to develop frailty to very frail elderly persons receiving palliative care in the final period of their lives. The interventions also address the different requirements that arise with regard to professional contributions during the various phases of the ageing and disease process, ranging from health promotion to a need for an increasing degree of medical care, nursing, special care and rehabilitation, and finally, efforts that promote symptom relief, quality of life, security and satisfaction with care during the final period of life. The intervention Elderly persons in the risk zone addresses elderly persons that are on the point of developing frailty (pre-frail) and are beginning to feel that they are being hindered from taking part in everyday activities. The hypothesis is that if an intervention is made when the persons are not so frail, it is possible to prevent/delay deterioration. 1. Can a health-promoting and preventive intervention for prefrail elderly persons: * prevent frailty, activity limitations and morbidity, * be a supportive factor in the social and physical environment, * affect life satisfaction * have an impact on the consumption of care * be cost-effective? 2. How do the frail elderly persons experience the intervention and its importance to health?
Interventions
BEHAVIORALpreventive home visit
BEHAVIORALsenior meetings
Sponsors
Vardalinstitutet The Swedish Institute for Health Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
80 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 80 years of age or older living in the community. * The participants should live in their ordinary housing * Independent on formal support * Independent on informal support * Cognitive intact defined as a Mini Mental Test score \> 25
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dependence in Two or More Activities of Daily Living (ADL) | 1 year | ADL stair case: Independence of, or dependence on, another person in ADL was assessed according to a cumulative scale of well-defined personal and instrumental activities, the ADL staircase. Nine out of the ten original activities were used; Cleaning, shopping, transportation, cooking, bathing, dressing, going to the toilet, transfer, and feeding (0-9). Dependence was defined as another person being involved in the activity by giving personal or directive assistance. People living together were assessed as independent if they performed the activity when alone. The number of partipants with dependence in two or more ADL at follow-up have been analyzed |
| Number of Partipants Measured Frail at 1-year Follow up | 1 year | Frailty defined as a sum of weakness, fatigue, weight loss, low physical activity, poor balance, slow gait speed, visual impairment and impaired cognition |
| Self Rated Health | 1 year | Self rated health was measured by the question In general would yoy say your health is: excellent, very good, good, fair or poor? Number of participants detoriated in self-rated health has been analysed |
Countries
Sweden
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| 1 Preventive Home Visits This intervention included a single home visit made by either a nurse, a physiotherapist, a qualified social worker or an occupational therapist. Participants received verbal and written information/advice about what the districts could provide. The preventive home visit was guided by a protocol, which included an opportunity for individuals to further elaborate on certain elements. The visit lasted between one and a half to two hours. | 174 |
| 2 Senior Meetings The intervention senior meetings comprised four weekly meetings with about six participants in each group. The main purpose was to focus on two different topics: 1) information about the ageing process and its consequences and 2) provision of tools and strategies for solving problems that can arise in the home environment. A follow-up home visit took place two to three weeks after the group sessions were completed. The group meetings were led either by an occupational therapist, a registered nurse, a physiotherapist or a qualified social worker, all of whom spoke about their particular dimension of aging. They jointly planned and carried out the intervention and were responsible for their specific part of the meetings. T The participants' experiences formed the basis of the meetings. A booklet was especially produced for the meetings, which includes texts that cover different areas of health, discussed at each of the meetings (table 1). http://www.vardalinstitutet.net/livslots.pdf. | 171 |
| 3 Control Group The control group had access to the ordinary range of services if requested from the urban districts for the aged. The aim of the municipal provision of care for the older persons is to ensure the ability to live as independently as possible. This includes remaining in their homes. When an older person in Sweden has difficulties managing independently, she or he can apply for assistance from the district. The extent of such support is subject to an assessment of needs and includes meals on wheels, help with cleaning and shopping, assistance with personal care, safety alarms and transportation service. The older person are also offered healthcare, provided either by municipal home help or home medical care services. | 114 |
| Total | 459 |
Baseline characteristics
| Characteristic | 2 Senior Meetings | 3 Control Group | 1 Preventive Home Visits | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 171 Participants | 114 Participants | 174 Participants | 459 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous ≥80 years | 85 years | 86 years | 86 years | 86 years |
| Region of Enrollment Sweden | 171 participants | 114 participants | 174 participants | 459 participants |
| Sex: Female, Male Female | 113 Participants | 70 Participants | 111 Participants | 294 Participants |
| Sex: Female, Male Male | 58 Participants | 44 Participants | 63 Participants | 165 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 174 | 0 / 171 | 0 / 114 |
| serious Total, serious adverse events | 0 / 174 | 0 / 171 | 0 / 114 |
Outcome results
Primary
Dependence in Two or More Activities of Daily Living (ADL)
ADL stair case: Independence of, or dependence on, another person in ADL was assessed according to a cumulative scale of well-defined personal and instrumental activities, the ADL staircase. Nine out of the ten original activities were used; Cleaning, shopping, transportation, cooking, bathing, dressing, going to the toilet, transfer, and feeding (0-9). Dependence was defined as another person being involved in the activity by giving personal or directive assistance. People living together were assessed as independent if they performed the activity when alone. The number of partipants with dependence in two or more ADL at follow-up have been analyzed
Time frame: 1 year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| 1 Preventive Home Visits | Dependence in Two or More Activities of Daily Living (ADL) | 35 participants |
| 2 Senior Meetings | Dependence in Two or More Activities of Daily Living (ADL) | 26 participants |
| 3 Control Group | Dependence in Two or More Activities of Daily Living (ADL) | 44 participants |
p-value: <0.0595% CI: [0.15, 0.48]Chi-squared
p-value: 0.0010.05% CI: [0.24, 0.68]Chi-squared
Primary
Number of Partipants Measured Frail at 1-year Follow up
Frailty defined as a sum of weakness, fatigue, weight loss, low physical activity, poor balance, slow gait speed, visual impairment and impaired cognition
Time frame: 1 year
Population: ITT was used. The basic assumption was that older adults (80+) deteriorate over time in the natural course of the aging process. The imputation method chosen was to replace missing values with a value based on the Median Change of Deterioration (MCD) a conservative form of worst case between baseline and follow-up.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| 1 Preventive Home Visits | Number of Partipants Measured Frail at 1-year Follow up | 80 participants |
| 2 Senior Meetings | Number of Partipants Measured Frail at 1-year Follow up | 85 participants |
| 3 Control Group | Number of Partipants Measured Frail at 1-year Follow up | 43 participants |
p-value: <0.0595% CI: [0.96, 2.52]Chi-squared
p-value: <0.0595% CI: [0.79, 2.08]Chi-squared
Primary
Self Rated Health
Self rated health was measured by the question In general would yoy say your health is: excellent, very good, good, fair or poor? Number of participants detoriated in self-rated health has been analysed
Time frame: 1 year
Population: ITT
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| 1 Preventive Home Visits | Self Rated Health | 31 participants |
| 2 Senior Meetings | Self Rated Health | 29 participants |
| 3 Control Group | Self Rated Health | 31 participants |
p-value: <0.0595% CI: [0.31, 0.97]Chi-squared
p-value: <0.0595% CI: [0.33, 1.02]Chi-squared