Functional resistance activities to impact frailty: A protocol for a randomized controlled trial involving home care aide and frail older adult dyads

Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study

Background

Home-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support.

Methods

Using an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table.

Results

Of the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for ‘care and assistance at home’ and ‘meal services’). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care.

Conclusions

Given the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03552-z.

Evaluating frailty in Medicaid Home and Community-based Services clients: a feasibility and comparison study between the SHARE-FI and SPPB

Background

Frailty assessment most commonly occurs within health care settings by health care providers. Implementing frailty assessment within non-medical settings that provide comprehensive social services for older adults may be an opportunity for population-based frailty screening and care. One such non-medical setting in which older adults receive care is Medicaid Home and Community-based Services (HCBS). Determining the feasibility of frailty screening within this non-medical setting is the first step towards population-based frailty assessment and care. The aims of this study were to (1) determine the feasibility of evaluating frailty using two different approaches (the Survey of Health Among Retired Europeans-Frailty Instrument (SHARE-FI) and Short Physical Performance Battery (SPPB)) among HCBS clients, (2) determine the agreement between the methods, and (3) explore specific frailty deficits on these measures to provide detailed knowledge on HCBS client impairments.

Methods

This cross-sectional study occurred in HCBS client homes throughout the Chicagoland area. A research assistant with no health care provider training conducted all frailty assessments. We used the freely available SHARE-FI calculator to generate both a categorical and continuous frailty score. We used the SPPB to capture both a categorical score with frailty categories assigned as 0-6 (frail), 7-9 (pre-frail), and 10-12 (non-frail) and continuous score. We evaluated feasibility via domains of acceptability, implementation, adaptation, and practicality. We used Cohen's kappa and Spearman's correlation to determine agreement between frailty tools.

Results

We enrolled n = 139 HCBS clients. Frailty assessment was feasibility via both the SHARE-FI and SPPB. The SHARE-FI was more practical given the fewer training needs, shorter administration time, and reduced equipment needs. There was a statically significant fair agreement between SHARE-FI and SPPB categorical scores with stronger agreement between SHARE-FI and SPPB continuous scores (r = - 0.448, p < .005; 95% CI, - 0.571, - 0.305). Among the five frailty criteria on the SHARE-FI, a pattern emerged of the highest frequency of positive responses to each criterion among frail clients followed by pre-frail and then non-frail.

Conclusions

Frailty assessment is feasible within HCBS settings conducted by a non-medical provider. Using continuous frailty scores provides stronger agreement between measures compared with categorical scores. Frailty can be feasibly measured in a non-medical setting providing initial evidence for a mechanism for population screening and care for frailty in HCBS.

Developing a health interview tool for Medicaid home and community-based services clients and home care aides through a community-engaged approach

We describe a community-engaged approach to develop and pilot a home care aide (HCA) administered health interview with Medicaid Home and Community-based Services clients. Stakeholders identified five priority health topics and selected a card sorting methodology for interviews. A barrier to interviewing clients was decreased communication skills among HCAs, and we modified health interview training to include communication training. Stakeholders reported the interview methodology was feasible within usual care, acceptable to clients, and contributed to increased knowledge on providing person-centered care. Stakeholder engagement resulted in valuable insights regarding the health interview methodology and relevant training needs.

Relationship between SHARE-FI Frailty Scores and Physical Performance Measures in Older Adult Medicaid Recipients

The Survey of Health, Ageing and Retirement in Europe-Frailty Instrument (SHARE-FI) is a frailty assessment tool designed for primary care settings comprised of four self-report questions and grip strength measurement, yet it is not known how SHARE-FI scores relate to objective physical performance measures that assess physical functioning, fall risk, and disability. This cross-sectional, observational study examined the association between SHARE-FI scores and a battery of physical performance measures in a sample of older adult, Medicaid waiver recipients (n = 139, mean age = 74.19 ± 8.36 years). We administered the SHARE-FI, Timed Up and Go (TUG), gait speed, and Short Physical Performance Battery (SPPB) in participants' homes. Among clients, 45% were frail, 35% pre-frail, and 20% non-frail. There were significant differences in all physical performance measure scores with respect to SHARE-FI category. SHARE-FI continuous scores significantly predicted TUG time, all domains of the SPPB, gait speed, and inability to complete the chair rise test. Self-reported walking difficulty and objectively measured gait speed were significantly correlated. The SHARE-FI continuous frailty score predicts scores on a variety of validated physical performance measures. Given the fast administration time, the SHARE-FI could potentially be used to serve as a surrogate for physical performance measures with known association with physical function, fall risk, and disability.

Design and development of a mobile exercise application for home care aides and older adult medicaid home and community-based clients

We describe a community-engaged approach with Medicaid home and community-based services (HCBS), home care aide (HCA), client, and physical therapist stakeholders to develop a mobile application (app) exercise intervention through focus groups and interviews. Participants desired a short exercise program with modification capabilities, goal setting, and mechanisms to track progress. Concerns regarding participation were training needs and feasibility within usual care services. Technological preferences were for simple, easy-to-use, and engaging content. The app was piloted with HCA-client dyads (n = 5) to refine the intervention and evaluate content. Engaging stakeholders in intervention development provides valuable user-feedback on both desired exercise program contents and mobile technology preferences for HCBS recipients.