Authors:

Abstract

Introduction: Frailty is a multifactorial syndrome that increases vulnerability to stressors, leading to a higher risk of adverse health events. Several non-pharmacological interventions, including lifestyle changes, have been studied as alternatives to reduce or attenuate frailty in older adults. 

Older adults with cognitive impairment (CI) have higher multimorbidity and frailty prevalence, lower functional status, and, consequently, an increased likelihood to develop dementia, non-cognitive deficits (e.g., falls, physical disability), and adverse health-related events (e.g., hospitalization, institutionalization). Nevertheless, intervention studies on frail individuals frequently exclude persons with CI.

+AGIL, a real-world program for frail older adults in a primary care area of Barcelona, is a pragmatic, multicomponent intervention implemented since 2016. It includes a multifactorial intervention (i.e., physical activity, nutrition, sleep hygiene, revision and adequacy of pharmacological treatment, detection of undesired loneliness and screening for CI) to improve physical function in community-dwelling older adults. Empowerment of the participants and fostering of their community engagement are also critical component of the intervention. Its implementation was based on three main principles: integrated care (among geriatric team, primary care physician, and community and third sector resources), co-design with end-users, and sustainability over time.

Objectives: To assess the longitudinal impact on physical function among community-dwelling frail older persons with CI.

Results:  194 participants (68% women), screening with the Gerontopole FST, were included (82 with CI, 112 without CI, based on previous diagnosis or the Mini-COG screening tool), with mean age(SD)=81,6(5,8) years old. Participants were mostly independent in Activities of Daily Living (mean Barthel Index=92,4, SD=11,1). They had relatively high prevalence of comorbidities and polypharmacy; 47,4% had experiences at least one fall in the last year.

A physical activity program (10 weekly sessions by an expert physical therapist in the whole sample) showed high adherence (87.6% attended ≥75% sessions). At three months, there was a clinically and statistically significant improvement at the Short Physical Performance Battery (SPPB) and its subcompenents in the whole sample and after stratification for CI. At six months, SPPB and gait speed remained stable in the study sample and subgroups. CI had no significant impact on the improvement of the SPPB or gait speed.

Conclusion: Our results suggest that older adults with CI can benefit from a multidisciplinary integrated and comprehensive geriatric intervention to improve physical function, a component of frailty.

Sustainability and transferability: +AGIL has changed the usual clinical practice in the involved centers. Also, older adults with frailty and CI, an increasing population usually excluded from these interventions, receive benefits from this program. Following the principles of care integration and users’ involvement, which lead to sustainability over time, +AGIL can be quickly adopted, adapted, and replicated in other areas and contexts.