A multicomponent frailty intervention for socioeconomically vulnerable older adults: a designed-delay study

Abstract

Purpose: The primary aim of this study was to evaluate the effectiveness of a 6-month multicomponent intervention on physical function in socioeconomically vulnerable older adults in rural communities. As secondary aims, we evaluated the effectiveness of the intervention on frailty and other geriatric syndromes, sustained benefit at 12 months, and baseline characteristics associated with poor response.

Patients and methods: This designed-delay study was conducted in 187 adults (mean age: 77 years; 75% women) who were living alone or on a low income in three rural regions of Korea. A 24-week multicomponent program that consisted of group exercise, nutritional supplementation, depression management, deprescribing medications, and home hazard reduction was implemented with a planned 6-month interval from August 2015 through January 2017. The primary outcome was physical function, measured using the Short Physical Performance Battery (SPPB) score (range: 0-12; minimum clinically important difference ≥1) at 6 months. Secondary outcomes included frailty phenotype, sarcopenia, Mini Nutritional Assessment-Short Form score (range: 0-14), Center for Epidemiologic Studies-Depression Scale score (range: 0-60), and falls.

Results: At 6 months, the SPPB score increased by 3.18 points (95% CI: 2.89, 3.48) from baseline. The program improved frailty (odds ratio: 0.06; 95% CI: 0.02, 0.16), sarcopenia (odds ratio: 0.32; 95% CI: 0.15, 0.68), Mini Nutritional Assessment-Short Form score by 1.67 points (95% CI: 1.28, 2.06), and Center for Epidemiologic Studies-Depression Scale score by -3.83 points (95% CI: -5.26, -2.39), except for fall (rate ratio: 0.99; 95% CI: 0.69, 1.43). These beneficial effects were sustained at 12 months. Body mass index ≥27 kg/m² and instrumental activities of daily living disability at baseline were associated with poor improvement in the SPPB score.

Conclusion: This 24-week multicomponent program had sustained beneficial effects up to 1 year on physical function, frailty, sarcopenia, depressive symptoms, and nutritional status in socioeconomically vulnerable older adults in rural communities. (ClinicalTrials.gov, NCT 02554994).

Keywords: clinical trial; exercise; frailty; geriatric assessment; malnutrition; public health practice.

Figure 1

Study design and population of the Aging Study of Pyeongchang Rural Area, an intervention study. Notes: Participants for this study were selected from the Aging Study of Pyeongchang Rural Area, a population-based, prospective cohort study of aging in 1,267 adults aged 65 years or older who live in three regions of Pyeongchang County, Gangwon Province, Korea. The 24-week intervention was delivered in one geographic region at a time. Enrolled individuals in region A participated in the multicomponent intervention program from August 2015 through January 2016; those in region B did so from February 2016 through July 2016; and those in region C participated from August 2016 through January 2017. All participants were assessed every 6 months for physical function. Abbreviation: ASPRA, Aging Study of Pyeongchang Rural Area.

Figure 2

Physical function before and after multicomponent intervention program. Notes: The mean (node) and SD (vertical bar) of the SPPB score are presented for participants in the three geographic regions before and after the multicomponent intervention program. The intervention period is denoted in red. The table below the graph presents the mean±SD for each region. Abbreviation: SPPB, Short Physical Performance Battery.

Figure 3

Prediction of response to multicomponent intervention program. Notes: Good responders were defined as either those having an increase of >1 point in the SPPB score over the 24-week intervention period compared with the baseline score, or those with a total SPPB score increase of >10 points (range: 0–12 points; higher score indicates better physical function) at 6 months. Numbers on the top of the graph represent the number of poor responders/number of participants in each category. Abbreviations: BMI, body mass index; IADL, instrumental activities of daily living; SPPB, Short Physical Performance Battery.