Interventions to prevent disability in frail community-dwelling elderly: a systematic review.
BACKGROUND
There is an interest for intervention studies aiming at the prevention of disability in community-dwelling physically frail older persons, though an overview on their content, methodological quality and effectiveness is lacking.


METHODS
A search for clinical trials involved databases PubMed, CINAHL and Cochrane Central Register of Controlled Trials and manually hand searching. Trials that included community-dwelling frail older persons based on physical frailty indicators and used disability measures for outcome evaluation were included. The selection of papers and data-extraction was performed by two independent reviewers. Out of 4602 titles, 10 papers remained that met the inclusion criteria. Of these, 9 were of sufficient methodological quality and concerned 2 nutritional interventions and 8 physical exercise interventions.


RESULTS
No evidence was found for the effect of nutritional interventions on disability measures. The physical exercise interventions involved 2 single-component programs focusing on lower extremity strength and 6 multi-component programs addressing a variety of physical parameters. Out of 8 physical exercise interventions, three reported positive outcomes for disability. There was no evidence for the effect of single lower extremity strength training on disability. Differences between the multi-component interventions in e.g. individualization, duration, intensity and setting hamper the interpretation of the elements that consistently produced successful outcomes.


CONCLUSIONS
There is an indication that relatively long-lasting and high-intensive multicomponent exercise programs have a positive effect on ADL and IADL disability for community-living moderate physically frail older persons. Future research into disability prevention in physical frail older persons could be directed to more individualized and comprehensive programs.
Daniels
Ramon
R
Faculty of Health and Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands. r.daniels@hszuyd.nl
van Rossum
Erik
E
de Witte
Luc
L
Kempen
Gertrudis I J M
GI
van den Heuvel
Wim
W
D000203:Activities of Daily Living; D000368:Aged; D005081:Exercise Therapy; D016330:Frail Elderly; D006801:Humans; D051346:Mobility Limitation; D016032:Randomized Controlled Trials as Topic