Sarcopenia and frailty prevention and management are highly prioritized goals in the Healthy Aging agenda. The study aims to evaluate the effects and implementation of the digital critical pathway to improve sarcopenia and frailty, reduce fall risk, and increase health-related quality of life among community-dwelling older adults with risk of, or diagnosed with, sarcopenia and frailty
Population ageing is accelerating globally and regionally, widening the gap between life expectancy and healthy life expectancy, mainly due to late-life declines in physical function and mobility (Guo et al., 2022). Sarcopenia and frailty are major age-associated public health issues that contribute to a decline in functional ability, increased fall risks, and mortality (Lee et al., 2022; Petermann-Rocha et al., 2021). Nutrition and physical activity integrated interventions are recommended as primary treatment for sarcopenia and frailty (Park \& Lee, 2023). However, current interventions are often generic, resulting in non-precise, non-personalized interventions, usually failing to accommodate individual differences in baseline strength and mobility, nutrition status, comorbidities, preferences, and home environments (Tighe et al., 2020). Consequently, interventions are complex to personalise, adjustments are delayed, and adherence is suboptimal, undermining real-world effectiveness. Future community-based health agendas should prioritize long-term care that removes access barriers (such as mobility and transportation) and transitions from generic care to precision personalization. The World Health Organisation's Decade of Healthy Ageing and the Integrated Care for Older People (ICOPE) framework provide a practice anchor to maintain intrinsic capacity through person-centred assessment, individualised goal-setting, and continuous follow-up. Within this paradigm, sarcopenia and frailty management apply ICOPE via protocol-driven critical pathways (Sum et al., 2022)-structured decision support that links risk assessment to tailored prescriptions and follow-up-can standardise quality while enabling precise personalisation across diverse home settings. Digital health interventions have expanded their capabilities to include remote exercise prescription, microlearning, reminders, and tele-coaching, with evidence of benefits for physical activity, fitness, body composition, and patient-reported outcomes (De Santis et al., 2023). Utilising a user-friendly digital tool to streamline functional assessments and develop personalised health plans is a promising approach. A digital platform-enabled intervention, grounded in the WHO ICOPE framework and a protocol-driven critical pathway, is proposed to identify care needs among community-dwelling older adults. This tool will allow healthcare providers to accurately assess individual needs and tailor interventions in exercise and nutrition, ensuring a focused, effective approach to combating sarcopenia and frailty in older adults.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
200
This digital program will address sarcopenia and frailty with a 12-week integrated intervention based on integrated exercise, nutrition, and fall-prevention. The intervention will be delivered by registered nurses, social workers, and health coach captains. Guided by the critical pathway and empowerment cycle framework, including a (1) Personalised Health Prescription Phase, (2) 12-Week Empowerment and Social Activity Phase, including six bi-weekly, in-person sessions empowerment workshop; scenario-based health message broadcast; case meeting.
The control group will receive general education on nutrition and physical activity guidelines for older adults, and the same pathway intervention will be applied to the control group after all data collection.
The University of Hong Kong
Hong Kong, Hong Kong
Appendicular skeletal muscle mass index (ASMI)
Appendicular skeletal muscle mass index (ASMI) measured by Bioelectrical impedance analysis (BIA)
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
Handgrip Strength
Handgrip strength will be measured by a hydraulic hand dynamometer from dominant hand, taking the highest value among 3 measurements. Low muscle strength is defined if male \<28kg, and femal \<18kg.
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
Short Physical Performance Battery (SPPB)
Physical function will be measured by the Short Physical Performance Battery (SPPB), which combines balance test, gait velocity and chair stand. SPPB score ranges from 0-12, higher score better physical performance. Low physical function is defined by SPPB score ≤9.
Time frame: baseline (T0), 3 months (T1), and 3 months (T2)
Sarcopenia and calf circumference scale (SARC-CalF)
Sarcopenia and calf circumference scale (SARC-CalF) includes 5 items (strength, assistance with walking, rising from a chair, climbing stairs, Falls, calf circumference). The score ranges from 0 to 20 points, with a score ≥ 11 points suggestive of sarcopenia.
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
11-item Edmonton Frail Scale
The Edmonton Frail Scale (EFS) is scored from 0 to 17, with higher scores indicating greater frailty. An EFS score ≥ 8 is generally used as the cutoff for frailty. Scores 6-7 flag patients who are at risk.
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
Timed Up and Go (TUG) test
Measured by the Timed Up and Go Test in unit of second. A shorter completion time indicates better mobility and balance.
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
The Mini Nutritional Assessment (MNA)
Measured by the Mini Nutritional Assessment (scores range from 0 to 30), with a lower score indicating a higher risk of malnutrition.
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
International Physical Activity Questionnaire (IPAQ-Short)
Measured by International Physical Activity Questionnaire is a self-report measure of physical activity. Frenquency and time spent on walking, moderate and vigorous physical activity will be reported. More time spent on physical actiivty indicating a higher physical activity level.
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
Sleep duration
Sleep duration in daytime and night on weekday and weekend
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
The EuroQoL-5D-5L instruments
Assess the health-related quality of life to generate the utility score for cost-effective analysis. It consists of two parts, with the first part to assess the health status on mobility, self-care, usual activities, pain/discomfort, and anxiety/depression using a 5-level (no problems, slight problems , moderate problems, severe problems and unable to) response set, with "unable to" levels mean a worse situation. The second part as a 0-100 scores VAS to measure perceived health, higher scores mean a better outcome.
Time frame: Baseline (T0), 3 months (T1), and 6 months (T2)
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