Building resilience and reversing frailty: a randomised controlled trial of a primary care intervention for older adults

医学 物理疗法 随机对照试验 握力 置信区间 心理干预 干预(咨询) 生物电阻抗分析 优势比 老年学 体质指数 内科学 护理部
作者
John Travers,Román Romero‐Ortuño,John Langan,Fergal MacNamara,Darren McCormack,Christopher McDermott,Jude McEntire,Joanne McKiernan,Seán Lacey,Peter Doran,Dermot Power,Marie Therese Cooney
出处
期刊:Age and Ageing [Oxford University Press]
卷期号:52 (2) 被引量:26
标识
DOI:10.1093/ageing/afad012
摘要

Abstract Background There is a need for effective primary care interventions that help older people combat frailty and build resilience. Objective To study the effectiveness of an optimised exercise and dietary protein intervention. Design Multicentre, randomised-controlled, parallel-arm trial. Setting Six primary care practices, Ireland. Methods Six general practitioners enrolled adults aged 65+ with Clinical Frailty Scale score ≤5 from December 2020 to May 2021. Participants were randomised to intervention or usual care with allocation concealed until enrolment. Intervention comprised a 3-month home-based exercise regime, emphasising strength, and dietary protein guidance (1.2 g/kg/day). Effectiveness was measured by comparing frailty levels, based on the SHARE-Frailty Instrument, on an intention-to-treat basis. Secondary outcomes included bone mass, muscle mass and biological age measured by bioelectrical impedance analysis. Ease of intervention and perceived health benefit were measured on Likert scales. Results Of the 359 adults screened, 197 were eligible and 168 enrolled; 156 (92.9%) attended follow-up (mean age 77.1; 67.3% women; 79 intervention, 77 control). At baseline, 17.7% of intervention and 16.9% of control participants were frail by SHARE-FI. At follow-up, 6.3 and 18.2% were frail, respectively. The odds ratio of being frail between intervention and control groups post-intervention was 0.23 (95% confidence interval: 0.07–0.72; P = 0.011), adjusting for age, gender and site. Absolute risk reduction was 11.9% (CI: 0.8%–22.9%). Number needed to treat was 8.4. Grip strength (P < 0.001) and bone mass (P = 0.040) improved significantly. 66.2% found the intervention easy, 69.0% reported feeling better. Conclusion A combination of exercises and dietary protein significantly reduced frailty and improved self-reported health.
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