frailty rehabilitation

Conditions: Frailty

Summary: frailty is an important clinical state that contributes to falls, hospitalization, institutionalization and death. when an individual simultaneously has many health problems, a frailty "tipping point" may be triggered by even a minor stressful event such as adding a new drug or urinary tract infection. our research suggests that approximately 23% of canadians over age 65 are frail, and by age 85 this estimate increases to over 40%. as we learn more about frailty and its consequences, there is an urgent need to develop community-based interventions that will prevent or delay frailty in older adults. our proposed study will examine if frailty rehabilitation program is an effective community-based intervention to promote healthy aging. the primary objective of our study is to determine if 4-month frailty rehabilitation improves physical function compared with control and exercise alone in community-dwelling older adults living with frailty and sarcopenia. secondary objectives of our study are to determine if 4-months of frailty rehabilitation can improve functional abilities and reduce healthcare utilization during a 6-month follow-up period compared with control and exercise alone. results will translate the first canadian model of frailty and sarcopenia rehabilitation and management.

in this multi-arm randomized controlled trial (rct), 324 community-dwelling older adults (aged 65+) with frailty and at high risk for mobility disability will be randomized into one of three arms (control, exercise only, multi-modal rehabilitation) stratified by sex, age and location preference. rolling recruitment will occur with ten cohorts total (2-3 cohorts per site, n=33 participants per cohort), enrolled across the partner young men's christian association (ymca) sites. building upon the rct, we aim to understand which components of a functional rehabilitation program are essential to change the trajectory of sarcopenia in older adults and explore the feasibility of a functional rehabilitation program with older adults. all participants will be screened for sarcopenia at baseline. of the 324 participants, a subset of participants with sarcopenia will undergo additional assessments. a validated frailty questionnaire can be administered over the phone and will provide an estimate of frailty status. stratified block randomization (1:1 randomization ratio) with the allocation sequence generated by a computer will be used to randomly allocate eligible participants to their group assignment. participants will be stratified based on their sex, age (\ =80 years), and location preference. to protect against selection bias, the randomization sequence will be adequately concealed so that investigators/participants are not aware of the upcoming assignment. the proposed duration of treatment is 4-months. primary and secondary outcomes will be assessed at 0 and 4-months.

Eligibility criteria:
inclusion criteria: * community-dwelling ≥65 years of age * able to independently ambulate 25m with or without walking aid * at high risk for mobility disability/functional limitations * received medical clearance * can arrange transportation to the ymca up to 2x/week * proof of being fully vaccinated against covid-19 and proof of identification exclusion criteria: * unable to speak or understand english * currently attending a group exercise program * currently in a drug optimization study/program * currently taking protein supplements daily * significant cognitive impairment where they may have difficulty following two-step commands in group exercise * receiving palliative/end of life care * unstable angina or heart failure * unable to attend for more than 20% of trial duration