Enhancing Frailty Status and Health-Related Quality of Life in Community-Dwelling Frail Older Adults

Abstract

Introduction: Frailty poses a significant concern among older adults residing in the community, impacting their health and quality of life. This study investigated the effectiveness of the Fitness and Nutrition Program for Seniors (FANS) in addressing frailty and enhancing health-related quality of life. The study aimed to evaluate the effects of a 6-month FANS on frailty status and health-related quality of life in community-dwelling frail older adults, and to compare the effects on fall efficacy, pain intensity, daily activities, stages of physical activity and nutrition behavior change, and satisfaction following the intervention.

Methods: A quasi-experimental design was used to assess the FANS among frail older adults (ClinicalTrials.gov Identifier NCT05242549). The intervention, based on the Transtheoretical Model, was conducted in a mixed setting, combining in-person sessions held at a community care center and remote group care delivered through the LINE app. The experimental group (43 individuals) received the FANS intervention, while the control group (38 individuals) continued with standard health promotion activities provided at the same community care center. Intention-to-treat analysis evaluated the intervention's impact. Measurements were taken before the intervention and at the 3-month and 6-month marks to assess changes in frailty status (using Cardiovascular Health Study criteria), health-related quality of life (Short Form-12), fall efficacy (Short Falls Efficacy Scale International), pain intensity (Pain Visual Analogue Scale), and daily activities (Instrumental Activities of Daily Living scale). Behavior change stages and satisfaction were monitored using the Fitness and Nutrition for Seniors Behavior Change Stages and Satisfaction Scale.

Results: Within the experimental group, significant improvements were observed over time across multiple measures, indicating intragroup effects, including frailty, overall health-related quality of life, fall efficacy, pain intensity, and daily activities. Between-group effects demonstrated statistically significant differences in daily activities. Time and group effects showed statistically significant improvements in frailty at 3 months and 6 months post-intervention. Following the intervention, a substantial percentage of participants in the experimental group progressed in behavior change stages related to physical activity and diet, with 83.72% in the action and maintenance stages for physical activity behavior change and 81.40% in those for dietary behavior change. The overall satisfaction rating for the program was 9.25 out of 10 (mean ± SD: 9.25 ± 0.24).

Conclusion: The FANS is a feasible and innovative community health promotion initiative tailored specifically for frail older adults residing in the community, particularly during a pandemic. This program has demonstrated significant improvements in frailty status, health-related quality of life, fall efficacy, pain intensity, and daily activities among community-dwelling frail older adults. Moreover, the program has facilitated notable advancements in behavior change stages, supporting community-dwelling frail older adults in adopting and maintaining healthy behaviors effectively.

Keywords: Fitness; Frailty; Health-related quality of life; Nutrition; Older adults.