Measuring the effects of nurse-led frailty intervention on community-dwelling older people in Ethiopia: a quasi-experimental study

Abstract

Background: Despite the critical need, interventions aimed at frailty in sub-Saharan Africa are scarce, attributed to factors such as insufficient healthcare infrastructure, the pressing need to address infectious diseases, maternal and child health issues, and a general lack of awareness. Hence, the aim of this research was to develop, implement, and evaluate the effect of a nurse-led program on frailty and associated health outcomes in community-dwelling older individuals in Ethiopia.

Methods: This study utilised a pre-test, post-test, and follow-up single-group quasi-experimental design. The main outcome measure was to determine changes in the frailty levels of older individuals living in communities at three different intervals: initially (T0), immediately after the intervention (T1), and 12 weeks following the intervention (T2). Secondary outcomes were the observed changes in daily living activities, nutritional status, depression levels, and quality of life (QOL), evaluated at each of these data collection points. To analyse changes in frailty and response variables over these periods, Friedman's ANOVA and Cochran's Q test were employed, setting the threshold for statistical significance at P < 0.05.

Results: Sixty-six older people with a high adherence rate of 97% completed the intervention and the follow-up measurements. Participants had an average age of 66.7 ± 7.9 years, with females comprising 79.4% of the group. Notably, 12 weeks post-intervention, there was a marked decrease in frailty (χ²(2) = 101.05, p < 0.001) and depression scores (χ²(2) = 9.55, p = 0.008) compared to the baseline. However, the changes in depression, physical, mental, and environmental domains of QOL were not sustained for 12 weeks post-intervention. Study participants showed an improvement in nutritional status (χ²(2) = 25.68, p < 0.001), activity of daily living (χ²(2) = 6.00, p = 0.05), and global quality of life (χ²(2) = 20.64, p < 0.001).

Conclusions: The nurse-led intervention notably, 12 weeks post-intervention reduced frailty and depression. The intervention improved the nutritional status and some components of the quality of life of the participants. There is a need for further studies, especially with larger participant groups and stronger research designs such as randomized controlled trials (RCTs).

Trial registration: ClinicalTrials.gov: NCT05754398 (03/03/2023).

Keywords: Aged; Community; Effects; Ethiopia; Frailty; Intervention; Nurse.

Fig. 1

The flow chart of educational intervention of the study, 2023

Fig. 2

Percentage of change in frailty score (A), risk of weight loss (B), depressive symptoms (C), and activity of daily living (D) measurements over time (n = 66), 2023