134Delaying and Reversing Frailty: A Systematic Review of Primary Care Interventions

Abstract

Background: Frailty is a fast growing medical and societal challenge given our ageing population and advances in life expectancy. Routine frailty screening is now recommended in primary-care internationally However, there is a lack of evidence on the most effective and practical interventions once frailty has been identified. We conducted a systematic review of primary-care interventions for frailty and mapped their effectiveness and ease of implementation. Methods: We searched PubMed, CINAHL, the Cochrane Library and PEDro up to September 2017 for English language RCTs or cohort studies on primary-care interventions for frailty. Selected studies were analysed for frailty screening method, type of intervention and outcomes. Outcomes were scored for effectiveness in terms of impact on frailty status or frailty criteria and scored for ease of implementation in terms of human resource, marginal cost and time requirements. Results: 894 studies satisfied our initial search criteria and 43 were selected for full analysis. The total number of participants in selected studies was 15,440 and the average study size was 377. The studies reflected broad heterogeneity of interventions. 20 studies involved physical activity interventions and other reported interventions included health education, nutritional supplementation, home care visits, hormone supplementation and counselling. Two thirds of studies involved more than one intervention. 14 studies reported the outcome of an intervention on frailty status and 10 of these (71%) demonstrated significant improvement. 29 studies reported the outcome of an intervention on singular frailty indicators or other criteria and 19 (66%) demonstrated significant improvement. Interventions with both muscle strength training and protein supplementation consistently placed highest for relative effectiveness and ease of implementation. Conclusion: A combination of muscle strength training and protein nutritional supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement. We have created a map of published interventions to inform choices for managing frailty.