title: Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies.
abstract: frailty impacts older adults' ability to recover from an acute illness, injuries and other stresses. Currently, a systematic synthesis of available interventions to prevent or reduce frailty does not exist. Therefore, we conducted a scoping review of interventions and international policies designed to prevent or reduce the level of frailty in community-dwelling older adults.
  
  
  
  we conducted a scoping review using the framework of Arksey and O'Malley. We systematically searched articles and grey literature to identify interventions and policies that aimed to prevent or reduce the level of frailty.
  
  
  
  fourteen studies were included: 12 randomised controlled trials and 2 cohort studies (mean number of participants 260 (range 51-610)), with most research conducted in USA and Japan. The study quality was moderate to good. The interventions included physical activity; physical activity combined with nutrition; physical activity plus nutrition plus memory training; home modifications; prehabilitation (physical therapy plus exercise plus home modifications) and comprehensive geriatric assessment (CGA). Our review showed that the interventions that significantly reduced the number of frailty markers present or the prevalence of frailty included the physical activity interventions (all types and combinations), and prehabilitation. The CGA studies had mixed findings.
  
  
  
  nine of the 14 studies reported that the intervention reduced the level of frailty. The results need to be interpreted with caution, as only 14 studies using 6 different definitions of frailty were retained. Future research could combine interventions targeting more frailty markers including cognitive or psychosocial well-being.
authors.affiliation: University of Toronto-Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
authors.forename: Martine T E
authors.initials: MTE
authors.lastname: Puts
authors.affiliation: University of Toronto-Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
authors.forename: Samar
authors.initials: S
authors.lastname: Toubasi
authors.affiliation: Dalhousie University-Division of Geriatric Medicine, Halifax, Nova Scotia, Canada.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Andrew
authors.affiliation: University of British Columbia-Family Practice, Vancouver, British Columbia V5Z 1M9, Canada.|University of British Columbia-Centre for Hip Health and Mobility -7 F-2635 Laurel St., Vancouver, British Columbia V5Z 1M9, Canada.
authors.forename: Maureen C
authors.initials: MC
authors.lastname: Ashe
authors.affiliation: McMaster University-School of Nursing, Hamilton, Ontario, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: University of Toronto-Gerstein Information Science, Toronto, Ontario, Canada.
authors.forename: Esther
authors.initials: E
authors.lastname: Atkinson
authors.affiliation: University of Toronto-Gerstein Information Science Centre, Toronto, Ontario, Canada.
authors.forename: Ana Patricia
authors.initials: AP
authors.lastname: Ayala
authors.affiliation: University Health Network-Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
authors.forename: Angelique
authors.initials: A
authors.lastname: Roy
authors.affiliation: University of Toronto-Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rodríguez Monforte
authors.affiliation: Department of Family Medicine, McGill University-Geriatric Medicine, Montréal, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Bergman
authors.affiliation: University Health Network-Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: McGilton
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D003071:Cognition; D015444:Exercise; D005260:Female; D016330:Frail Elderly; D000073496:Frailty / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D015577:Geriatric Assessment; D005853:Geriatrics / Q000331:legislation & jurisprudence*; D033161:Government Regulation; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D057187:Independent Living / Q000331:legislation & jurisprudence*; D008297:Male; D008603:Mental Health; D015596:Nutrition Assessment; D009752:Nutritional Status; D011050:Policy Making; D011788:Quality of Life
keywords: frail elderly; interventions; nutrition; older people; physical activity; scoping review