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THE NEED TO DEVELOP INTERVENTIONS TO PREVENT DISABILITY IN FRAIL OLDER PEOPLE

 

B. Fougère1,2,3

 

1. Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; 2. Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; 3. Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA

Corresponding to: B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France.
Tel: +33561145657 ; fax: +33561145640. E-mail address: b.fougere@gmail.com

Care Weekly 2018;1:5-6
Published online May 4, 2018, http://dx.doi.org/10.14283/cw.2018.2

 


Key words: Disability, frailty, interventions, older people, prevention.


 

The number and proportion of older people in the global population are rapidly rising (1). Frailty is a multidimensional geriatric concept that influences several domains (2), and it is directly related to adverse consequences, such as falls, disability, the need for long term care, hospitalization, and even mortality (3–5). These adverse outcomes constitute a source of considerable healthcare expenditure, and it is known that the reduction of adverse outcomes could lead to an offset in medical costs (6). In this sense, the clinical outcomes related to frailty should be treated to prevent the socioeconomic burden associated with this condition. There is evidence suggesting that frailty is a potentially modifiable dynamic process characterized by frequent transitions between states over time. Given its multidimensional nature, reversing frailty requires a comprehensive approach. In this context, several studies testing the effects of pharmacological approach, physical activity, nutritional intervention, or cognitive training and even multidomain interventions has to be developed.
Over the last decades, several intervention studies against disability in the older people using frailty indicators as inclusion criteria have been reported. It is possible to identify people who are frail for inclusion in a randomized trial and frailty can be successfully treated using an interdisciplinary multidomain program. There is the potential to reduce disability in community dwelling people who are frail. A recent review summarizes the findings of lessons learned from clinical trials (7). Specific interventions targeting physical activity have been shown to improve physical function (8–11), and intervention with nutritional supplements has resulted in increased energy intake and improved strength (12). The Mediterranean-style diet was also shown to be associated with a slower decline in mobility over time in community-dwelling older persons (13). Pharmacological interventions have produced inconsistent results (14–17). On the contrary, several clinical trials in older persons have shown that multidomain interventions are effective in improving morbidity, disability, hospitalization, institutionalization, and mortality (18–20).
However, there is substantial heterogeneity in frailty studies, in terms of intervention content and duration, study populations, length of follow-up, and outcome measures. Moreover, one of the most important limitations of research in this area is the lack of an agreed upon standardized global clinical definition of the frailty syndrome. Standardization of trial methods, especially in terms of duration of follow-up, comparators, target population definitions, and outcome measures, would enable the comparison of effect sizes across different types of interventions. Further researches are needed to establish the optimum type, duration, timing, and intensity of lifestyle-based interventions, and the clinical meaningfulness of any beneficial effects.
To be effective worldwide, interventions against disability in frail older adults must be feasible, inexpensive, and easy to implement in a wide range of settings, in addition to being safe. These interventions must aim at maximizing personal independence and minimizing personal disability so that individuals may delay or even avoid institutionalization (21). Lifestyle interventions, particularly multidomain interventions targeting physical exercise, cognitive training, and nutritional approach, could be a key component of our efforts to be effective against disability. The success of these interventions will be also linked to the capacity of the scientific community to involve other influential actors, such as policy makers and industrial partners, to facilitate access to specific interventions.

 

Conflict of Interest

BF declares no conflict of interest.

Authors’ contributions

BF made substantial contributions to conception and design. BF wrote the manuscript.

 

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