The Frailty In Residential Sector over Time (FIRST) study: methods and baseline cohort description

Published online: 03 February 2021Background: The Frailty In Residential Sector over Time (FIRST) Study is a 3-year prospective cohort study investigating the health of residents living in residential aged care services (RACS) in South Australia. The study aims to examine the change in frailty status and associated health outcomes. Methods: This interim report presents data from March 2019–October 2020. The study setting is 12 RACS from one organisation across metropolitan and rural South Australia involving 1243 residents. All permanent (i.e. respite or transition care program excluded) residents living in the RACS for at least 8 weeks were invited to participate. Residents who were deemed to be medically unstable (e.g. experiencing delirium), have less than 3 months to live, or not fluent in English were excluded. Data collected included frailty status, medical diagnoses, medicines, pain, nutrition, sarcopenia, falls, dementia, anxiety and depression, sleep quality, quality of life, satisfaction with care, activities of daily living, and life space use at baseline and 12-months. Data Linkage will occur over the 3 years from baseline. Results: A total of 561 permanent residents (mean age 87.69 ± 7.25) were included. The majority of residents were female (n = 411, 73.3%) with 95.3% (n = 527) being classified as either frail (n = 377, 68.2%) or most-frail (n = 150, 27.1%) according to the Frailty Index (FI). Most residents were severely impaired in their basic activities of daily living (n = 554, 98.8%), and were at-risk of malnutrition (n = 305, 55.0%) and at-risk of sarcopenia (n = 492, 89.5%). Most residents did not experience pain (n = 475, 85.4%), had normal daytime sleepiness (n = 385, 69.7%), and low anxiety and depression scores (n = 327, 58.9%). Conclusion: This study provides valuable information on the health and frailty levels of residents living in RACS in South Australia. The results will assist in developing interventions that can help to improve the health and wellbeing of residents in aged care services. Trial registration: Prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN1261 9000500156).Agathe Daria Jadczak, Leonie Robson, Tina Cooper, J. Simon Bell, Renuka Visvanathan, on behalf of the FIRST Study Collaborator

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services.

Background Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). Objective The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. Methods Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. Results Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. Conclusions Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions.Laura A. Dowd, Amanda J. Cross, Shin J. Liau, Agathe D. Jadczak, Renuka Visvanathan, Felicity C. Veal, J. Simon Bel

Educating medical students in counselling older adults about exercise: the impact of a physical activity module

Background: Exercise courses during medical school contribute to medical students’ confidence in promoting physical activity to their patients. However, there is still a lack of uniform physical activity education across medical school curricula to equip medical students with the necessary skills and knowledge to counsel their patients about exercise. Objective: To determine the effects of a 1.5-hour physical activity module including a one-hour exercise tutorial combined with a 30-minute practical counselling session on senior medical students’ perceptions of the importance of exercise and their perceived competence in advising older people about exercise. Design: Pre-post survey. Setting: University campus. Participants: 161 senior medical students taking part in the Queen Elizabeth Hospital Geriatric Medicine course in 2015 (control group) and 2016 (intervention group). Measurement: The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered before and after a 4.5-week Geriatric Medicine Course. Scores ranged from 1 (not important or competent) to 6 (very important or competent). The independent T-Test and repeated-measures ANOVA was used to determine differences between intervention and control group. Results: Medical students perceived exercise-related skills to be highly important (score ≥4) in both the intervention (4.85 ± 0.37) and control group (4.78 ± 0.67), pre-course. The overall perceived importance could not be significantly increased by the physical activity module (P=0.082). The physical activity module, however, improved medical students’ perceived competence in six out of ten exercise-related skills, and increased their overall perceived competence in counselling older people about exercise (P<0.001). Conclusion: A 1.5-hour physical activity module improves senior medical students’ perceived competence in counselling older people about exercise. This research proves that little teaching space is needed to impact positively on medical students’ exercise counselling abilities.A.D. Jadczak, K.L. Tam, R. Visvanatha

The perspectives of pre-frail and frail older people on being advised about exercise: a qualitative study

Advance Access publication 14 November 2017Background. Exercise is considered to be the most effective strategy to treat, prevent and delay frailty, a prevalent geriatric syndrome observed in clinical practice. Encouraging frail older people to take up exercise is crucial in the management of this condition. The study aimed to explore pre-frail and frail older peoples’ perspectives in relation to being advised about exercise and their perceptions of the general practitioners’ (GPs) role in promoting exercise for older people. Methods. Semi-structured interviews were conducted with 12 community-dwelling older (median age 83 years) participants screened pre-frail or frail using the FRAIL Screen. Their attitudes towards exercise, the advice received, their access to relevant information and their perceptions of the GP’s role in promoting exercise were explored. Thematic analysis was conducted to analyse data. Results. The majority of participants had a positive attitude towards exercise, and many participants indicated a preference for being advised firstly by their GPs and then other healthcare professionals. Participants living in the community reported difficulties in accessing information on exercise and indicated that local governments and GP practices should promote exercise for older people more actively. Participants living in retirement villages, however, reported having access to relevant information and being encouraged to participate in exercise. Conclusion. This research identified a gap in current practice, demonstrating that GPs, healthcare providers and local governments should promote exercise for older people more actively. Convincing health professionals to encourage regular exercise among their older patients would provide an opportunity to avoid and manage frailty in this population.Agathe Daria Jadczak, Joanne Dollard, Neha Mahajan and Renuka Visvanatha

A randomized controlled pilot Exercise and Protein Effectiveness Supplementation Study (EXPRESS) on reducing frailty risk in community-dwelling older people

Published online: 10 Mar 2021.This pilot study aimed to examine the feasibility and effectiveness of a 6-months multi-component exercise program combined with twice daily consumption of either rice (RicePro) or whey-based (WheyPro) protein supplements (2 × 20 g of protein) on gait speed, grip strength and physical performance in community-dwelling pre-frail and frail older adults. Secondary outcomes included: frailty score, muscle mass, quality of life, nutritional intake, cognitive performance, depression and physical activity levels. A total of 70 participants (mean age 73.34 ± 6.85 years) were randomly allocated to either RicePro (n = 36) or WheyPro (n = 34). No adverse events were reported in regards to the exercise, however, several gastrointestinal symptoms were noted with the whey protein causing two-fold more symptoms compared to the rice protein. No differences were found between the groups (p > 0.05), except the total consumed energy (kJ) (p = 0.014) and fat (g) (p = 0.012) which was significantly lower in WheyPro. The results indicate that the quality of protein may not be as important as long as a sufficient amount is consumed.Agathe Daria Jadczak, Renuka Visvanathan, Robert Barnard, and Natalie Luscombe-Mars

Sarcopenia risk in nursing home residents using SARC-F: first study findings

First published: 13 January 2022AIM: Sarcopenia is a common disorder of loss of muscle mass and function among older adults; however, few studies have examined screening instruments for sarcopenia risk in residential aged care services (RACS). The aims of this study were to measure sarcopenia risk in RACS residents using the SARC-F, describe factors associated with sarcopenia risk and examine the predictive validity of the SARC-F for 12-month mortality. METHODS: This was a prospective cohort study carried out in South Australian RACS across 12 sites. In total, 541 residents (mean age 87.7 [7.3] years, 72.6% women) were included in the study. Sarcopenia risk was measured using a modified SARC-F (≥4 point cut point). RESULTS: We identified 89.5% (n = 484) of residents at risk of sarcopenia. Significant (P > 0.05) predictors of sarcopenia risk in multivariable analysis included the presence of diabetes (relative risk [RR] = 1.08), classification as most-frail (RR = 1.06) and smaller Nursing Home Life Space Diameter (NHLSD) score (RR = 0.99). Mortality was observed in 20.9% (n = 113) of residents over a 12-month follow-up. Classification as at-risk of sarcopenia was a significant predictor of 12-month mortality; however, it had a poor area under the receiver operator curve (0.56), and a low positive predictive value (23.1%). The best performing cut-point of ≥7 also had poor discriminative ability (under the receiver operator curve = 0.66, positive predictive value = 30.8%). CONCLUSIONS: Sarcopenia risk is extremely common among RACS residents and its presence is a significant contributor to 12-month mortality. Low discriminative ability for the SARC-F was noted across multiple cut-off scores for predicting mortality at 12 months. Diabetes management and promoting physical activity and nutrition among RACS residents are likely to influence sarcopenia risk positively.Mark Q Thompson, Agathe D Jadczak, Solomon Yu, Graeme R Tucker, Renuka Visvanatha

Sedentary behaviour in hospitalised older people: a scoping review

Background: Sedentary behaviour (SB) can delay hospitalised older adults’ recovery from acute illness and injuries. Currently, there is no synthesis of evidence on SB among hospitalised older people. This scoping review aimed to identify and map existing literature on key aspects of SB among hospitalised older adults, including the prevalence, measurement and intervention strategies for SB and sedentary behaviour bouts (SBBs) as well as healthcare professionals, patients and carers’ perspectives on interventions. Methods and analysis: Several electronic databases were searched between January 2001 and September 2020. The Joanna Briggs Institute (JBI) framework was used to conduct this scoping review. Results: Out of 1824 articles, 21 were included comprising 16 observational studies, 3 randomised controlled trials, 1 comparative study, and 1 phase-1 dose-response study. The sample size ranged from 13 to 393, with all 1435 participants community-dwelling before hospitalisation. Only two studies focused on measuring SB and SBBs as a primary outcome, with others (n = 19) reporting SB and SBB as a sub-set of physical activity (PA). Older adults spent an average of 86.5%/day (20.8 h) sedentary. Most studies (n = 15 out of 21) measured SB and SBB using objective tools. Conclusion: Hospitalised older people spent most of their waking hours sedentary. Studies explicitly focused on SB and SBB are lacking, and the perspectives of patients, carers and healthcare professionals are not clarified. Future hospital-based studies should focus on interventions to reduce SB and SBB, and the perspectives of healthcare professionals, patients and carers’ taken into account.Unyime Jasper, Lalit Yadav, Joanne Dollard, Agathe Daria Jadczak, Solomon Yu and Renuka Visvanatha

Sedentary behaviour in hospitalised older people: a scoping review protocol

Background: Older adults spend up to 23 h daily sitting or lying while in hospital. Sedentary behaviour (SB) within a hospital setting is often associated with poor health outcomes including physical and cognitive decline, reduced quality of life and death as well as hospital readmissions. Conversely, replacing SB with mild to moderate levels of physical activity such as walking can significantly reduce hospital readmission risk by 30 days. Given the potentially harmful effects of SB in hospitalised older adults, it is vital to identify current literature by broadly exploring different aspects of SB among older people in hospital. The overall aim of this scoping review is to produce a literature map of current evidence on key domains of sedentary behaviour in hospitalised older people. Method: A search for relevant publications will be undertaken in Pedro, MEDLINE Ovid, Cochrane, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, Embase, Ageline, Joanna Briggs Institute (JBI) and clinical trials registries. Publications in English and those where the author can provide the full text in English will be included. Studies conducted in hospitals (including in-patient rehabilitation facilities) or acute and subacute care settings and in people aged ≥ 65 will be included. A three-stage method will be used to identify relevant articles, consisting of database search using keywords, keywords and index words across all databases, and reference searching. Articles will be selected following screening of titles/abstracts succeeded by a full-text appraisal utilising a standardised selection form. Two independent reviewers will extract data using the standardised form that will be tested on two articles. A narrative summary will accompany results presented in tables and figures.Unyime S. Jasper, Lalit Yadav, Agathe Daria Jadczak, Solomon Yu, Renuka Visvanathan, and Joanne Dollar