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01-12-2009 | Review

Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review

Authors: Susanne Gustafsson, Anna-Karin Edberg, Boo Johansson, Synneve Dahlin-Ivanoff

Published in: European Journal of Ageing | Issue 4/2009

Abstract

The objective was to investigate definitions of frailty used in studies of multi-component health promotion and disease-preventive (HPDP) intervention programmes for community-dwelling frail elderly persons and to review the content, organisation and effects of HPDP interventions. A systematic review of 19 articles was made, and the International Classification of Functioning, Disability and Health (ICF) was used as a structural framework for the analysis. The result shows that a consensus was reached on including various aspects of impairments in body functions and structures as an integral part of the frailty concept, with the exception of one subgroup: mental/cognitive functions. Additionally, opinions varied quite consistently regarding aspects of activity limitations and participation restrictions, personal and environmental factors. Ten of the 14 HPDP programmes covered various intervention elements referring to all four ICF components. Eleven programmes involved registered personnel only, while a more divergent pattern was seen in the remaining organisational aspects of the interventions: length of interventions and location plus age segments, participatory approach and contextual information, as well as the theoretical foundation of the interventions. Measures of body functions and structures were significantly improved in 5 out of 17 (29%) targeted aspects. For activity and participation, 12 out of 32 (38%) targeted aspects were positively changed, while the score for environmental factors was 7 out of 22 (32%), and for personal factors 8 out of 22 (36%). Our review suggests that further research is needed to explore and disentangle the complex interrelationships between various interventions and outcomes.

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Avlund K, Damsgaard MT, Schroll M (2001) Tiredness as determinant of subsequent use of health and social services among nondisabled elderly people. J Aging Health 13(2):267--286 CrossRef

Avlund K et al (2002) Tiredness in daily activities among nondisabled old people as determinant of onset of disability. J Clin Epidemiol 55(10):965–973 CrossRef

Beswick AD, Rees K et al (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 371(9614):725–735CrossRef

*Bouman A, van Rossum E et al (2008a) Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in The Netherlands. J Am Geriatr Soc 56(3):397–404

*Bouman A, van Rossum E et al (2008b) Effects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands. J Gerontol A Biol Sci Med Sci 63(3):291–297

Bouman A, van Rossum E et al (2008c) Effects of intensive home visiting programs for older people with poor health status: a systematic review. BMC Health Serv Res 8:74CrossRef

Bradley EH, Bogardus ST Jr et al (1999) Goal-setting in clinical medicine. Soc Sci Med 49(2):267–278CrossRef

*Chin APMJ, de Jong N et al (2001) Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: a randomized controlled trial. Arch Phys Med Rehabil 82(6):811–817

*Chin APMJ, de Jong N et al (2002) Physical exercise or micronutrient supplementation for the wellbeing of the frail elderly? A randomised controlled trial. Br J Sports Med 36(2):126–131

Concato J, Shah N et al (2000) Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 342(25):1887–1892CrossRef

Craig P, Dieppe P et al (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337:a1655CrossRef

*Dalby DM, Sellors JW et al (2000) Effect of preventive home visits by a nurse on the outcomes of frail elderly people in the community: a randomized controlled trial. CMAJ 162(4):497–500

Elkan R, Kendrick D et al (2001) Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ 323(7315):719–725CrossRef

Ferrucci L, Guralnik JM et al (2004) Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 52(4):625–634CrossRef

Fried LP, Tangen CM et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156

Gill TM (2005) Education, prevention, and the translation of research into practice. J Am Geriatr Soc 53(4):724–726CrossRef

*Gill TM, Baker DI et al (2002) A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 347(14):1068–1074

Gill TM, Baker DI et al (2003) A prehabilitation program for physically frail community-living older persons. Arch Phys Med Rehabil 84(3):394–404CrossRef

*Gill TM, Baker DI et al (2004) A prehabilitation program for the prevention of functional decline: effect on higher-level physical function. Arch Phys Med Rehabil 85(7):1043–1049

Gill TM, Gahbauer EA et al (2006) Transitions between frailty states among community-living older persons. Arch Intern Med 166(4):418–423CrossRef

*Gitlin LN, Hauck WW et al (2006a) Effect of an in-home occupational and physical therapy intervention on reducing mortality in functionally vulnerable older people: preliminary findings. J Am Geriatr Soc 54(6):950–955

*Gitlin LN, Winter L et al (2006b) A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. J Am Geriatr Soc 54(5):809–816

*Hall N, Beck PD et al (1992) Randomized trial of a health promotion program for frail elderly. Can J Aging 72–91

*Hebert R, Robichaud L et al (2001) Efficacy of a nurse-led multidimensional preventive programme for older people at risk of functional decline. A randomized controlled trial. Age Ageing 30(2):147–153

Hogan DB, MacKnight C et al (2003) Models, definitions, and criteria of frailty. Aging Clin Exp Res 15(3 Suppl):1–29

*Holland SK, Greenberg J et al (2005) Community-based health coaching, exercise, and health service utilization. J Aging Health 17(6):697–716

Huss A, Stuck AE et al (2008) Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci 63(3):298–307

Jette AM (2006) Toward a common language for function, disability, and health. Phys Ther 86(5):726–734

Kemm J (2006) The limitations of ‘evidence-based’ public health. J Eval Clin Pract 12(3):319–324CrossRef

*Leveille SG, Wagner EH et al (1998) Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care. J Am Geriatr Soc 46(10):1191–1198

*Mann WC, Ottenbacher KJ et al (1999) Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly. A randomized controlled trial. Arch Fam Med 8(3):210–217

Markle-Reid M, Browne G (2003) Conceptualizations of frailty in relation to older adults. J Adv Nurs 44(1):58–68CrossRef

*Markle-Reid M, Weir R et al (2006) Health promotion for frail older home care clients. J Adv Nurs 54(3):381–395

Nicolaides-Bouman A, van Rossum E et al (2004) Effects of home visits by home nurses to elderly people with health problems: design of a randomised clinical trial in the Netherlands [ISRCTN92017183]. BMC Health Serv Res 4(1):35CrossRef

Nicolaides-Bouman A, van Rossum E et al (2007) Home visiting programme for older people with health problems: process evaluation. J Adv Nurs 58(5):425–435CrossRef

Nourhashemi F, Andrieu S et al (2001) Instrumental activities of daily living as a potential marker of frailty: a study of 7364 community-dwelling elderly women (the EPIDOS study). J Gerontol A Biol Sci Med Sci 56(7):M448–M453

*Phelan EA, Williams B et al (2004) Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. J Gerontol A Biol Sci Med Sci 59(8):838–843

Reuben DB (1998) Warning sings along the road to functional dependency. Ann Intern Med 128(2):138--139

Rockwood K (2005a) Frailty and its definition: a worthy challenge. J Am Geriatr Soc 53(6):1069–1070CrossRef

Rockwood K (2005b) What would make a definition of frailty successful? Age Ageing 34(5):432–434CrossRef

*Rockwood K, Stadnyk K et al (2000) A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people. J Am Geriatr Soc 48(9):1080–1085

Rockwood K, Song X et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495

Rychetnik L, Frommer M et al (2002) Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health 56(2):119–127CrossRef

Rychetnik L, Hawe P et al (2004) A glossary for evidence based public health. J Epidemiol Community Health 58(7):538–545CrossRef

Schroll M (2006) Successful aging – utopia or a realistic target. State of the art lecture. In: 18th Nordic congress of gerontology. Jyväskylä, Finland

Socialstyrelsen (2005) Hälsofrämjande hälso- och sjukvård? En kartläggning av hälsofrämjande och sjukdomsförebyggande insatser. http://www.socialstyrelsen.se/NR/rdonlyres/92C2CE95-6381-4C6A-BC64-0CE4ABA2D54F/4287/200513135.pdf

Socialstyrelsen (2007) Vård och omsorg om äldre: lägesrapport 2007. http://www.socialstyrelsen.se/NR/rdonlyres/4D793100-E677-4E98-997F-4805BDB1FECC/9991/20081316.pdf

*Stuck AE, Minder CE et al (2000) A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med 160(7):977–986

Stuck AE, Egger M et al (2002) Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 287(8):1022–1028CrossRef

Sutton AJ, Abrams KR et al (1998) Systematic reviews of trials and other studies. Health Technol Assess 2(19):33–37

Tinetti ME, Baker DI et al (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 331(13):821–827CrossRef

Topinkova E (2008) Aging, disability and frailty. Ann Nutr Metab 52(Suppl 1):6–11

*van Haastregt JC, Diederiks JP et al (2000) Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial. BMJ 321(7267):994–998

van Haastregt JC, Diederiks JP et al (2000) Effects of preventive home visits to elderly people living in the community: systematic review. BMJ 320(7237):754–758CrossRef

van Tulder M, Furlan A et al (2003) Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 28(12):1290–1299CrossRef

Vass M, Avlund K et al (2005) Feasible model for prevention of functional decline in older people: municipality-randomized, controlled trial. J Am Geriatr Soc 53(4):563–568CrossRef

WHO (2009a) Health promotion glossary. http://www.who.int/hpr/NPH/docs/hp_glossary_en.pdf

WHO (2009b) ICF Application Areas. http://www.who.int/classifications/icf/appareas/en/

WHO (2009c) ICF, international classification of functioning, disability and health. http://www.who.int/classifications/icf/en/

Title: Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review
Authors: Susanne Gustafsson
Anna-Karin Edberg
Boo Johansson
Synneve Dahlin-Ivanoff
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: European Journal of Ageing / Issue 4/2009
Print ISSN: 1613-9372
Electronic ISSN: 1613-9380
DOI: https://doi.org/10.1007/s10433-009-0132-x

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Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review

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