The process of frailty can potentially be prevented and treated, particularly if interventions occur early. Therefore, it is important to know how to manage older adults with frailty or those at risk for developing it (Clegg et al., 2013). The present report focuses on six key fields of intervention that must be taken into consideration while tackling frailty, namely: prevention, clinical management, nutrition, physical exercise, medicines, and information and communication technologies (ICTs).
The objectives of Work Package 6 (WP6) for contributing to the state of art report were to collect and review the existing literature on the topics on the management of frailty at individual level, to identify and select examples of good practices on the management of frailty in these fields, and finally, to develop this report that could be used to illustrate the recommendations for frailty prevention at individual level.
By obtaining and analysing all these pieces of information and data, it is possible to determine what policies and policy issues need to be addressed, as well as which gaps exist and must be filled in the future to tackle frailty. In addition, it is possible to identify the gaps of knowledge in the fields that would benefit from further research.
The overall results of this WP indubitably contribute to the main goals of JAHEE JA as they pertain to the management of frailty at individual level: to create good practise guidelines for the prevention and clinical management of frailty at individual level and on the use of nutrition, medicines, physical exercise and ICTs to prevent, delay or manage frailty.
METHODS
Systematic literature review and good practices review was conducted to obtain the results on six tasks of the WP6 – the Management of Frailty at Individual Level: Prevention, Clinical management, Nutrition, Physical exercise, Medicines, and ICTs.
Peer-reviewed literature
A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P) 2015 guidelines (Moher et al., 2015), as it enables the obtainment of data from various sources, and ensures a holistic understanding of the research subject. The scientific literature reviews were performed analysing the following databases: PubMed, The Cochrane Library, Embase, UpToDate and Cumulative Index of Nursing and Allied Health Literature (CINAHL). The descriptive research methodology was used to review the peer-reviewed medical literature.
The criterion in selecting the literature was that articles were published in a time period of 15 years, from 2002 to 2017. Key words were selected from a proposal of key words that were prepared by task leaders and the working group on 6 tasks: Prevention, Clinical management, Nutrition, Physical activity, Drugs, and ICTs. Several combinations of selected search words (see Annex 1) in the English language and their synonyms were prepared and used with Boolean operators AND or OR, searching by title, key words and in abstract.
Articles regarding current policies and guidelines on 6 tasks which were published in peer‐ reviewed scientific journals, as well as in international documents, standards, guidelines, and research studies performed in the EU, were reviewed. Information from editorials, letters, interviews, posters, and articles with no access to full text were not included in the study. Grey documents which were identified and proposed by task leaders were also reviewed and included in the study. Grey documents were identified through an opportunistic search, meaning a targeted or focused one, based on the information that each partner was able to find regarding their own country.
In total, for Task Prevention, 391,910 search results were identified and 31 articles/sources included in analysis; for Task Clinical management, 67,432 search results were identified and 27 articles/sources included in analysis; for Task Nutrition, 39,885 search results were identified and 28 articles/sources included in analysis; for Task Physical activity, 620,043 search results were identified and 25 articles/sources included in analysis; for Task Drugs, 28,796 search results were identified and 25 articles/sources included in analysis; for Task ICTs, 124,634 search results were identified and 33 articles/sources included in analysis.
Grey literature
The collection of good practices was opportunistic, rather than systematic. It was based on the former European Union (EU)-funded programmes, European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) and Joint Action On Chronic Diseases And Promoting Healthy Ageing Across The Life-Cycle (JA CHRODIS), and key stakeholders and national policy documents known by partners.
Task leaders, as experts in the field, sought partners’ suggestions on good practices and submitted them to the WP Co-Leader. The Co-leader used the following exclusion criteria: Lack of relevance or respect to ethical principles; absence of evaluation (the practice should have been evaluated at least from a process evaluation perspective); and inability to be transferred to other settings (that includes a not clear enough description of the practice).
The inclusion criteria used were equity, sustainability, participation, and inter-sectoral collaboration. They were entered into an Excel spreadsheet and validated by internal reviewers using a bespoke points-based scoring system developed by the Co-leader. Each subcategory of the proposed criteria (they may be found in the Annex 2) was allocated equal weighting (ie. one point) and summed up to create the Good Practices score. The practices with scores higher than eighteen were identified and proposed below.