Frailty is a common clinical syndrome that is becoming increasingly important as populations age worldwide. Individuals who are frail are at a higher risk for negative outcomes, such as falls, disability, hospitalizations, and even death. The understanding of frailty has evolved from a straightforward concept to a complex model that includes physical, psychological, cognitive, and social factors. Since frailty is not static and can change over time, early interventions can be beneficial. Nevertheless, research in this area has been challenging due to a lack of agreement on what frailty encompasses and an inadequate understanding of how its different components interact. Defining frailty as a multidimensional issue is essential to recognize the adverse effects that can arise from medical, psychological, and social influences. However, recent studies have not sufficiently addressed how these different aspects work together or developed effective multidimensional interventions.
The study will be designed as a four-arm, double-blinded, cluster-randomised controlled trial. A sample (N = 308) of prefrail older adults aged 60-80 years will be recruited from 32 randomly selected elderly community centres in Hong Kong and classified into four frailty deficit patterns (multi-frailty, physical-to-psycho/social, nonphysical-to-psycho/social, and a robust control). With the hypothesised biopsychosocial framework pinpointing the intertwined relationships of these three domains of frailty, four intervention strategies (biological/psychosocial/nutritional, biological/nutritional, psychosocial/nutritional, and an inactive control) will be proposed to improve their overall frailty, regarding their physical, psychological, and social functioning, nutritional status, and lifestyle changes in a 9-month intervention and follow-up period. The primary objective will be to assess the effectiveness of the intervention strategies for improving the frailty status of participants in each of the four frailty deficit pattern groups, and to determine the most effective intervention strategy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
308
Involves participants engaging in physical training group sessions in light-to-moderate intensity.
Involves participants engaging in selected board and card games which require cognitive and socialization skills to play in a group setting of 2-4 people.
Involves participants attending dietary classes taught by a certified dietitian, including individualized consultation.
Frailty Status (pre-test)
The Tilburg Frailty Indicator (TFI), with three subdomains (physical, psychological, and social), will be used in three evaluation time frames, respectively. The total TFI score ranges from 0 to 15, with a score of 5 (or above) indicating frailty.
Time frame: Pre-test (1st test): before intervention
Frailty Status (2nd test)
The Tilburg Frailty Indicator (TFI), with three subdomains (physical, psychological, and social), will be used in three evaluation time frames, respectively. The total TFI score ranges from 0 to 15, with a score of 5 (or above) indicating frailty.
Time frame: 2nd test: after 3-month intervention
Frailty Status (3rd test)
The Tilburg Frailty Indicator (TFI), with three subdomains (physical, psychological, and social), will be used in three evaluation time frames, respectively. The total TFI score ranges from 0 to 15, with a score of 5 (or above) indicating frailty.
Time frame: 3rd test: after 6-month follow up
Physical Functioning-- Anthropometic Data (pre-test)
Anthropometric data (e.g. BMI in kg/m\^2) will be evaluated in 3 time frames, respectively.
Time frame: Pre-test (1st test): before intervention
Physical Functioning-- Anthropometric Data (2nd test)
Anthropometric data (e.g. BMI in kg/m\^2) will be evaluated in 3 time frames, respectively.
Time frame: 2nd test: after 3-month intervention
Physical Functioning-- Anthropometric Data (3rd test)
Anthropometric data (e.g. BMI in kg/m\^2) will be evaluated in 3 time frames, respectively.
Time frame: 3rd test: after 6-month follow up
Physical Functioning-- Health Related Information (pre-test)
Health-related information (heart rate, daily step counts, etc.) collected by a Smart Band will be used in three evaluation time frames, respectively.
Time frame: Pre-test (1st test): before intervention
Physical Functioning-- Health Related Information (2nd test)
Health-related information (heart rate, daily step counts, etc.) collected by a Smart Band will be used in three evaluation time frames, respectively.
Time frame: 2nd test: after 3-month intervention
Physical Functioning-- Health Related Information (3rd test)
Health-related information (heart rate, daily step counts, etc.) collected by a Smart Band will be used in three evaluation time frames, respectively.
Time frame: 3rd test: after 6-month follow up
Physical Functioning-- Senior Physical Fitness Test Battery (pre-test)
The senior physical fitness test battery (SPFT) (Jones, 2013) will be used in three evaluation time frames, respectively. The SPFT consists of six physical tests for assessing functional fitness in the elderly: 30 sec arm curl (muscular strength), 30 sec chair stand (muscular strength), 2 min step test (aerobic endurance), chair sit-and-reach (flexibility), back scratch test (flexibility), and up-and-go (dynamic balance).
Time frame: Pre-test (1st test): before intervention
Physical Functioning-- Senior Physical Fitness Test Battery (2nd test)
The senior physical fitness test battery (SPFT) (Jones, 2013) will be used in three evaluation time frames, respectively. The SPFT consists of six physical tests for assessing functional fitness in the elderly: 30 sec arm curl (muscular strength), 30 sec chair stand (muscular strength), 2 min step test (aerobic endurance), chair sit-and-reach (flexibility), back scratch test (flexibility), and up-and-go (dynamic balance).
Time frame: 2nd test: after 3-month intervention
Physical Functioning-- Senior Physical Fitness Test Battery (3rd test)
The senior physical fitness test battery (SPFT) (Jones, 2013) will be used in three evaluation time frames, respectively. The SPFT consists of six physical tests for assessing functional fitness in the elderly: 30 sec arm curl (muscular strength), 30 sec chair stand (muscular strength), 2 min step test (aerobic endurance), chair sit-and-reach (flexibility), back scratch test (flexibility), and up-and-go (dynamic balance).
Time frame: 3rd test: after 6-month follow up
Psychological Functioning (pre-test)
A seven-item scale of psychological well-being, which is an indicator of psychological functioning in the Comprehensive Model of Frailty (CMF) (Kwan et al., 2015), will be used in three evaluation time frames, respectively.
Time frame: Pre-test (1st test): before intervention
Psychological Functioning (2nd test)
A seven-item scale of psychological well-being, which is an indicator of psychological functioning in the Comprehensive Model of Frailty (CMF) (Kwan et al., 2015), will be used in three evaluation time frames, respectively.
Time frame: 2nd test: after 3-month intervention
Psychological Functioning (3rd test)
A seven-item scale of psychological well-being, which is an indicator of psychological functioning in the Comprehensive Model of Frailty (CMF) (Kwan et al., 2015), will be used in three evaluation time frames, respectively.
Time frame: 3rd test: after 6-month follow up
Social Function (pre-test)
The risk of social functioning deficits will be tested using the Social Frailty Index (SFI) in three evaluation time frames, respectively.
Time frame: Pre-test (1st test): before intervention
Social Function (2nd test)
The risk of social functioning deficits will be tested using the Social Frailty Index (SFI) in three evaluation time frames, respectively.
Time frame: 2nd test: after 3-month intervention
Social Function (3rd test)
The risk of social functioning deficits will be tested using the Social Frailty Index (SFI) in three evaluation time frames, respectively.
Time frame: 3rd test: after 6-month follow up
Physical Activity Behavioural Changes (pre-test)
Scales of physical activity behavioural change, intention/motivation, loneliness, subjective physical health, and health status will be measured using a survey that was used in a previous project (Chow et al., 2022), in three time frames.
Time frame: Pre-test (1st test): before intervention
Physical Activity Behavioural Changes (2nd test)
Scales of physical activity behavioural change, intention/motivation, loneliness, subjective physical health, and health status will be measured using a survey that was used in a previous project (Chow et al., 2022), in three time frames.
Time frame: 2nd test: after 3-month intervention
Physical Activity Behavioural Changes (3rd test)
Scales of physical activity behavioural change, intention/motivation, loneliness, subjective physical health, and health status will be measured using a survey that was used in a previous project (Chow et al., 2022), in three time frames.
Time frame: 3rd test: after 6-month follow up
Exercise Self-efficacy (pre-test)
Assessed using the validated Chinese scales of the Physical Exercise Self-efficacy Scale (PESES), a 5-item instrument with a 4-point Likert-type scale, ranging from 5 to 20. Higher scores shows higher routine physical exercise self-efficacy.
Time frame: Pre-test (1st test): before intervention
Exercise Self-efficacy (2nd test)
Assessed using the validated Chinese scales of the Physical Exercise Self-efficacy Scale (PESES), a 5-item instrument with a 4-point Likert-type scale, ranging from 5 to 20. Higher scores shows higher routine physical exercise self-efficacy.
Time frame: 2nd test: after 3-month intervention
Exercise Self-efficacy (3rd test)
Assessed using the validated Chinese scales of the Physical Exercise Self-efficacy Scale (PESES), a 5-item instrument with a 4-point Likert-type scale, ranging from 5 to 20. Higher scores shows higher routine physical exercise self-efficacy.
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Time frame: 3rd test: after 6-month follow up
Nutrition Self-efficacy (pre-test)
Assessed using the Nutrition Self-efficacy Scale (NSES) (Schwarzer, 2009; Wong et al., 2020).
Time frame: Pre-test (1st test): before intervention
Nutrition Self-efficacy (2nd test)
Assessed using the Nutrition Self-efficacy Scale (NSES) (Schwarzer, 2009; Wong et al., 2020).
Time frame: 2nd test: after 3-month intervention
Nutrition Self-efficacy (3rd test)
Assessed using the Nutrition Self-efficacy Scale (NSES) (Schwarzer, 2009; Wong et al., 2020).
Time frame: 3rd test: after 6-month follow up
Nutritional Status (pre-test)
Assessed by the Mini Nutritional Assessment scale (MNA). The MNA score ranges from 0 to 14, with a higher score indicating better nutritional status.
Time frame: Pre-test (1st test): before intervention
Nutritional Status (2nd test)
Assessed by the Mini Nutritional Assessment scale (MNA). The MNA score ranges from 0 to 14, with a higher score indicating better nutritional status.
Time frame: 2nd test: after 3-month intervention
Nutritional Status (3rd test)
Assessed by the Mini Nutritional Assessment scale (MNA). The MNA score ranges from 0 to 14, with a higher score indicating better nutritional status.
Time frame: 3rd test: after 6-month follow up