Delaying and reversing frailty: a systematic review of primary care interventions
Recommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identif...
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| Published in: | British journal of general practice Vol. 69; no. 678; p. e61 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
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England
01.01.2019
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| ISSN: | 1478-5242, 1478-5242 |
| Online Access: | Get more information |
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| Abstract | Recommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identified.
To assess the comparative effectiveness and ease of implementation of frailty interventions in primary care.
A systematic review of frailty interventions in primary care.
Scientific databases were searched from inception to May 2017 for randomised controlled trials or cohort studies with control groups on primary care frailty interventions. Screening methods, interventions, and outcomes were analysed in included studies. Effectiveness was scored in terms of change of frailty status or frailty indicators and ease of implementation in terms of human resources, marginal costs, and time requirements.
A total of 925 studies satisfied search criteria and 46 were included. There were 15 690 participants (median study size was 160 participants). Studies reflected a broad heterogeneity. There were 17 different frailty screening methods. Of the frailty interventions, 23 involved physical activity and other interventions involved health education, nutrition supplementation, home visits, hormone supplementation, and counselling. A significant improvement of frailty status was demonstrated in 71% (
= 10) of studies and of frailty indicators in 69% (n=22) of studies where measured. Interventions with both muscle strength training and protein supplementation were consistently placed highest for effectiveness and ease of implementation.
A combination of muscle strength training and protein supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement in primary care. A map of interventions was created that can be used to inform choices for managing frailty. |
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| AbstractList | Recommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identified.
To assess the comparative effectiveness and ease of implementation of frailty interventions in primary care.
A systematic review of frailty interventions in primary care.
Scientific databases were searched from inception to May 2017 for randomised controlled trials or cohort studies with control groups on primary care frailty interventions. Screening methods, interventions, and outcomes were analysed in included studies. Effectiveness was scored in terms of change of frailty status or frailty indicators and ease of implementation in terms of human resources, marginal costs, and time requirements.
A total of 925 studies satisfied search criteria and 46 were included. There were 15 690 participants (median study size was 160 participants). Studies reflected a broad heterogeneity. There were 17 different frailty screening methods. Of the frailty interventions, 23 involved physical activity and other interventions involved health education, nutrition supplementation, home visits, hormone supplementation, and counselling. A significant improvement of frailty status was demonstrated in 71% (
= 10) of studies and of frailty indicators in 69% (n=22) of studies where measured. Interventions with both muscle strength training and protein supplementation were consistently placed highest for effectiveness and ease of implementation.
A combination of muscle strength training and protein supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement in primary care. A map of interventions was created that can be used to inform choices for managing frailty. Recommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identified.BACKGROUNDRecommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identified.To assess the comparative effectiveness and ease of implementation of frailty interventions in primary care.AIMTo assess the comparative effectiveness and ease of implementation of frailty interventions in primary care.A systematic review of frailty interventions in primary care.DESIGN AND SETTINGA systematic review of frailty interventions in primary care.Scientific databases were searched from inception to May 2017 for randomised controlled trials or cohort studies with control groups on primary care frailty interventions. Screening methods, interventions, and outcomes were analysed in included studies. Effectiveness was scored in terms of change of frailty status or frailty indicators and ease of implementation in terms of human resources, marginal costs, and time requirements.METHODScientific databases were searched from inception to May 2017 for randomised controlled trials or cohort studies with control groups on primary care frailty interventions. Screening methods, interventions, and outcomes were analysed in included studies. Effectiveness was scored in terms of change of frailty status or frailty indicators and ease of implementation in terms of human resources, marginal costs, and time requirements.A total of 925 studies satisfied search criteria and 46 were included. There were 15 690 participants (median study size was 160 participants). Studies reflected a broad heterogeneity. There were 17 different frailty screening methods. Of the frailty interventions, 23 involved physical activity and other interventions involved health education, nutrition supplementation, home visits, hormone supplementation, and counselling. A significant improvement of frailty status was demonstrated in 71% (n = 10) of studies and of frailty indicators in 69% (n=22) of studies where measured. Interventions with both muscle strength training and protein supplementation were consistently placed highest for effectiveness and ease of implementation.RESULTSA total of 925 studies satisfied search criteria and 46 were included. There were 15 690 participants (median study size was 160 participants). Studies reflected a broad heterogeneity. There were 17 different frailty screening methods. Of the frailty interventions, 23 involved physical activity and other interventions involved health education, nutrition supplementation, home visits, hormone supplementation, and counselling. A significant improvement of frailty status was demonstrated in 71% (n = 10) of studies and of frailty indicators in 69% (n=22) of studies where measured. Interventions with both muscle strength training and protein supplementation were consistently placed highest for effectiveness and ease of implementation.A combination of muscle strength training and protein supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement in primary care. A map of interventions was created that can be used to inform choices for managing frailty.CONCLUSIONA combination of muscle strength training and protein supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement in primary care. A map of interventions was created that can be used to inform choices for managing frailty. |
| Author | Romero-Ortuno, Roman Travers, John Bailey, Jade Cooney, Marie-Therese |
| Author_xml | – sequence: 1 givenname: John surname: Travers fullname: Travers, John organization: Department of Geriatric Medicine, St Vincent's University Hospital and Trinity College Dublin HSE Specialist Training Programme in General Practice, Dublin – sequence: 2 givenname: Roman surname: Romero-Ortuno fullname: Romero-Ortuno, Roman organization: Global Brain Health Institute (GBHI), Trinity College Dublin, Mercer's Institute for Successful Aging, St James's Hospital, Dublin – sequence: 3 givenname: Jade surname: Bailey fullname: Bailey, Jade organization: Department of Medicine, University College Dublin, Dublin – sequence: 4 givenname: Marie-Therese surname: Cooney fullname: Cooney, Marie-Therese organization: Department of Geriatric Medicine, St Vincent's University Hospital, Dublin |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30510094$$D View this record in MEDLINE/PubMed |
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| Title | Delaying and reversing frailty: a systematic review of primary care interventions |
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