Highlights
- •We summarize 10 principles to implement complex interventions against frailty
- •+AGIL is a tailored program to revert frailty and delay disability in older persons
- •The +AGIL program translates the evidence from frailty trials into real practice
- •The +AGIL program integrates existing healthcare and community-based resources
- •+AGIL builds on users' participation and aims to empower the participants
Abstract
Background
Frailty is highly prevalent in older persons and associated with negative health-related
events and costs. Despite successful clinical trials, translation of evidence into
implementation of dedicated programs has been scarce. This is probably due to funding
limitations and lack of generalizability of rigid schemes adopted in controlled studies.
We propose a guidance to implement complex interventions against frailty in the community,
and describe the design and early findings of the +AGIL Barcelona program.
Methods
A guidance “decalogue” resulted from an experts' panel prioritization of recommendations
by international independent bodies. On this basis, we reorganized existing primary
care, geriatrics and community-based resources to implement our program, which includes
a screening, a multi-component intervention modulated on the comprehensive geriatric
assessment and integrated follow-up plus continuity through community-based resources.
The pre-post impact of the program on physical function, as well as on clinical endpoints,
person-center outcomes and costs will be assessed.
Results
Integrated care, multi-component, person-centered strategies to empower the final
users in a flexible and adaptable way should be promoted after raising awareness and
potentially convey long term investments. In 22 months, 185 participants (mean age ± SD = 81.6 ± 5.7 years,
72% women) joined the program. Although independent in the activities of daily living,
participants showed clear indicators of frailty (Short Physical Performance Battery = 7.1 ± 2.5;
gait speed = 0.69 ± 0.2 m/s).
Conclusions
+AGIL Barcelona may represent a unique model to manage frailty in older community-dwellers,
translating evidence into pragmatic clinical practice. Further research will clarify
the effects of this intervention.
Keywords
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Article info
Publication history
Published online: August 22, 2018
Accepted:
July 23,
2018
Received in revised form:
July 19,
2018
Received:
June 13,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
