Background: Frailty is a significant public health problem because of its impact on the functional capacity of the individual, as well as its high prevalence, such as the high consumption of resources that can lead to health and social care. Evidence on the effectiveness of interventions to prevent frailty is scarce. Objective: To assess the effect of an intervention based on a nutritional and physical activity program in preventing frailty progression in pre-frail elderly subjects. Study design: A randomized, open label, controlled trial with 2 parallel arms. Population: community-dwelling pre-frail elderly subjects (≥70 years) consulting in primary care. Intervention: Nutritional assessment (and derivation to a Nutritional Unit for usual care in the event of nutritional risk) and a physical activity program including aerobic exercise and a set of mixed strengthening, balance and coordination exercises to be done at home at least 4times/week. Control group: Patients receiving the usual care. Main outcome measures: Prevalence of frailty (Fried criteria), functional capacity (Barthel index), falls and nutritional status (Short-Form Mini Nutritional Assessment) on follow-up at 12 months. Results: The prevalence of frailty in the elderly of the community 70 years or more has been estimated at 31% and the prevalence of pre-frailty by 49%. At follow-up, 172 people who participated in the study, 4.9% of the intervention group and 15.3% of the control group had evolved to frailty, for a crude OR of 0.29 (95% CI: 0.08-1.08; p=.052) and an adjusted (by age, gender and number of co-morbidities) OR of 0.19 (95% CI: 0.04-0.95; p=.044). Study intervention improved outdoors walking hour per day (0.97 vs 0.73; p=.019) but not muscle strength, gait speed or other functional indicators. Among patients in the intervention group, 47.5% were considered good adherers and none of these evolved to frailty. Conclusions: An intervention focused on physical exercise and maintaining good nutritional status is effective in preventing frailty in community-dwelling pre-frail elderly individuals. The baseline characteristics associated with poor adherence to the intervention of study are social risk, the isolation, depression and reduced physical activity required.
Prevenció de la fragilitat en ancians pre-fràgils: Efectivitat d'una intervenció a l'Atenció Primària
Sist Viaplana, X. (Author). 22 Jul 2016
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis