A realist review to understand the efficacy and outcomes of interventions designed to minimise, reverse or prevent the progression of frailty

Interventions to minimise, reverse or prevent the progression of frailty in older adults represent a potentially viable route to improving quality of life and care needs in older adults. Intervention methods used across European Innovation Partnership on Active and Healthy Ageing collaborators were analysed, along with findings from literature reviews to determine 'what works for whom in what circumstances'. A realist review of FOCUS study literature reviews, 'real-world' studies and grey literature was conducted according to RAMESES (Realist and Meta-narrative Evidence Synthesis: Evolving Standards), and used to populate a framework analysis of theories of why frailty interventions worked, and theories of why frailty interventions did not work. Factors were distilled into mechanisms deriving from theories of causes of frailty, management of frailty and those based on the intervention process. We found that studies based on resolution of a deficiency in an older adult were only successful when there was indeed a deficiency. Client-centred interventions worked well when they had a theoretical grounding in health psychology and offered choice over intervention elements. Healthcare organisational interventions were found to have an impact on success when they were sufficiently different from usual care. Compelling evidence for the reduction of frailty came from physical exercise, or multicomponent (exercise, cognitive, nutrition, social) interventions in group settings. The group context appears to improve participants' commitment and adherence to the programme. Suggested mechanisms included commitment to co-participants, enjoyment and social interaction. In conclusion, initial frailty levels, presence or absence of specific deficits, and full person and organisational contexts should be included as components of intervention design. Strategies to enhance social and psychological aspects should be included even in physically focused interventions

Exploring a capacity to screen of the European Portuguese version of the 15-item Geriatric Depression Scale

Abstract: The aim of this study was to analyze the screening performance of the European Portuguese version of the 15-item Geriatric Depression Scale (GDS-15) against DSM-5 diagnostic criteria for major depressive episode. The study was multicentre and involved 139 older adults recruited in the context of primary healthcare. Twenty-three participants were diagnosed with clinical depression. Sensitivity and specificity for different cut-off points were determined based on ROC curve analyses. The cut-off point ≥ 4.5 provided optimal sensitivity (95.7%) and specificity (52.6%) rates. After exclusion from the analysis of illiterate participants’ data, the optimal cut-off point remained unchanged. The European Portuguese version of GDS-15 is an effective tool for depression screening in older adults. Further studies are needed to verify if there are factors, other than formal education, that may influence the scale’s performance. Resumen: Exploración de la capacidad de screening de la versión europea portuguesa de la Geriatric Depression Scale de 15 items. El objetivo del estudio fue comparar la capacidad de cribado de la versión europea portuguesa de la Geriatric Depression Scale de 15 ítems (GDS-15) respecto a los criterios del DSM-5 en relación con el trastorno depresivo mayor. El estudio fue multicéntrico e incluyó 139 ancianos (23 con diagnóstico de depresión) reclutados en un contexto de atención primaria. La sensibilidad y la especificidad para diferentes puntos de corte fueron obtenidas a través de curvas ROC. La relación de sensibilidad y especificidad reveló ser mejor en el punto de corte ≥ 4.5, resultante en sensibilidad del 95.7% y especificidad del 52.6%. Después de excluirse del análisis de los datos los participantes sin educación formal, el punto de corte óptimo permaneció sin cambios. La versión europea portuguesa de la escala GDS-15 es una herramienta efectiva para el screening de la depresión en ancianos. Se necesitan más estudios para verificar si hay otros factores que puedan influir en el rendimiento de la escala