Slowing Down and/or Preventing the Progression of Frailty in Older Adults

Dr. Patrick McGowan is the Associate Director of the Institute on Aging and Lifelong Health, a Professor in the School of Public Health and Social Policy at the University of Victoria, and the Director of Self-Management BC. Recently, Dr. McGowan has been leading a project aimed at developing a sustainable peer-led intervention to slow down and/or prevent the progression of frailty in British Columbia’s older adults.

Context

Self-Management BC (SMBC) has been implementing peer-led Self-Management programs to persons with chronic health conditions for approximately 25 years. During this time, SMBC has recruited and trained nearly 10,000 program leaders and coaches who have delivered programs to nearly 80,000 older adults with chronic health conditions. Several venues have been used to deliver the programs Including: in-person and virtual small group programs; on-line programs; individual self-help programs; and telephone coaching programs. Telephone contact was selected as the venue for the new frailty program.

To investigate the process and effectiveness of using peer coaches to deliver a telephone intervention to older adults who were concerned with becoming frail, two sequential studies were completed between 2017 and 2021 to investigate feasibility, viability, and effectiveness of a peer-developed telephone self-management programs.

The first longitudinal study (funded by the Lawson Foundation) took place between 2017-2019 and involved 115 adults with type 2 diabetes. Importantly, the study found that a telephone coaching was acceptable to both participants and care professionals results and found significant improvements in 10 patient-reported outcome measures (PROMS) as well in A1C level. The study showed that using peer coaches was feasible, viable, and effective.

A second a randomized trial funded by CIHR took place on Vancouver Island between 2019 and 2021 and involved 163 older persons with chronic conditions who were living in their own homes. The study evaluated the relative effectiveness of using peer coaches compared to using coaches where participants were also provided with three assistive devices, namely: a wristwatch which tracked steps; a scale which tracked weight, heart rate, and environmental data; and a sleep pad that tracked sleep cycles. Results were that participants with a coach (alone) reported improvements in seven areas, but participants who also had devices showed similar improvements in these measures, with even larger improvements. Follow-up interviews with participants revealed they felt the devices gave them more control over their conditions. These results held for all participants and were not impacted by the COVID-19 interruption nor covariates of age, sex, education level and number of chronic conditions.

Description of problem

With the aging population, frailty has become a major concern impacting the quality of life and health of older persons and has contributed to poorer health, lower quality of life and increased healthcare interventions for older adults. However, frailty is not a natural course of aging and can be avoided and/or decreased. In BC there were very few community-based inexpensive interventions that could be accessed by older persons who were concerned with becoming frail, and none of the programs have involved the utilization of trained peer-coaches.

Intervention
Based on the lessons learned in the first two studies and the experiences accrued during the several years implementing self-management programs, the intervention that was developed consisted of thirteen 45-minute weekly telephone calls made to participants by trained peer-coaches who instructed and supported them to:
• use three main self-management strategies: problem-solving, making and using action plans, and
using a process to assist them to make difficult decisions, and to:
• review and discuss each of the 5 strategies in the Federal Frailty AVOID Strategy to prevent frailty,
namely: Activity, Vaccinations, Optimizing medications; Interaction; and Diet. Over the 13 weeks
each of the five strategies was the main focus of two sequential calls with participants problem-solving and making action plans in these areas.

This study, a RCT, was funded by the Canadian Frailty Strategy, and took place in the Fraser Health Region in 2023. It involved 120 older adults who were living independently. This study evaluated effectiveness of peer coaches using self-management strategies and discussing components of the Canadian Frailty Network AVOID Strategy. Eligibility criteria were: living in the Fraser Health Region, living independently, and participants needed to score themselves between Levels 4 and 6 on the Rockwood Clinical Frailty Scale 1.

When interested persons completed the Consent Form and baseline questionnaire, they were randomly allotted to a group that received the program immediately or to a group that would wait five months before receiving the program. When they started the program the project coordinator gave them a watch and sleep pad to use during the study. Outcome measures were collected from all participants at baseline, and at five and ten months.

Changes
At ten months, two thirds of participants decreased their frailty level by one or two levels and there were
significant improvements in Depression, Self-Efficacy, and Activation Level.

Summary of the lessons learned
An inexpensive, easy to implement peer-delivered telephone Frailty Coach Program was effective in helping older adults with chronic conditions to manage their health outcomes, and slow-down and/or prevent the progression of frailty.

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