| BACKGROUNDThe aging process has accelerated in China,and the number of elderly people has increased.The health management and medical burden of the elderly have continued to increase.The government has formulated a medium-and long-term healthy aging development plan,which requires strengthening the health management of the elderly and attaching importance to the health risk management and prevention and control of chronic diseases.Frailty management has become a new perspective for the health management of the elderly around the world.Frailty refers to the non-specific state of the elderly's decline in physiological reserve and the decline of anti-stress ability.It increases the rate of elderly's fall,hospitalization,disability and other unhealthy health.At present,China lacks a Frailty screening instrument which is suitable for health care providers and a scientifically viable early screening and management program for frailty.OBJECTIVE1.To verify the reliability and validity of the Survey of Health,Ageing and Retirement in Europe Frailty instrument(SHARE-FI)and to provide a screening instrument for the health care providers;2.To investigate the frailty status of elderly people in Guangzhou and analyze the risk factors of frailty.This can enrich the data of frailty epidemics in the elderly people in China,and provide theoretical basis for the management of frailty risk factors;3.To formulate a frailty management programme which is suitable for the elderly among community-dwelling in China,and provide a scientific and normative basis for health care providers to manage the frailty of the elderly;4.To explore the barriers and facilitators to the implementation of the frailty management programme in the primary health care institutions,paving the way for the next step.METHODS1.Cross-cultural adaption of foreign scales:According to the Brislin translation model,SHARE-FI was translated,back-translated,cross-culturally adapted and pre-investigated to form a Chinese version of SHARE-FI,which is applied and evaluated in elderly in the community-dwelling of Guangzhou.The reliability and validity of the SHARE-FI was evaluated and explored its feasibility in general practice.2.Cross-sectional survey:We used the Chinese version of SHARE-FI and a pre-established questionnaire to conduct a cross-sectional survey of 1217 elderly people who met the inclusion and exclusion criteria.The aim is to determine the prevalence of frailty elderly people in Guangzhou and analyze frailty risk factors.3.Systematic literature review:We searched the clinical practice guidelines related to the prevention and management of frailty systematically,and used the Reporting items for practice guidelines in healthcare(RIGHT)to evaluate the quality of the included practice guides.Based on the summary of high-quality evidence and expert argumentation after the evaluation of the guidelines,a frailty management programme is developed,which is suitable for the elderly in general pratice.4.Semi-structured interview:Using the purpose sample to extract 18 health care provides from 2 community health service centers in Guangzhou and 16 community elderly,semi-structured face-to-face interviews was conducted.Barriers and facilitators which possible encounters in implementation strategy was analyzed from manager,health care providers and the elderly.RESULTS1.SHARE-FI reliability and validity test and feasibility evaluation:SHARE-Fl after cross-cultural adaption included 5 items,including 4 self-reported items and 1 measurement item.The reliability and validity of SHARE-FI showed that the sensitivity of each gender group and frailty status group was 86.42%?94.55%,the specificity was 89.45%-98.26%,the AUC of male group SHARE-FI was 0.978,0.957;The AUC of female group is 0.973,0.961.The Calibration correlation coefficient is r=0.808(P<0.001).The test-retest reliability ICC was 0.92(P<0.001).The Kappa value of inter-evaluator reliability was 0.87,and the consistency of the two measurements was 93.55%.2.The prevalence of frailty was 10.3%,30.7%were prefrail,35.4%were robust of 1 217 elderly people.An ordinal logistic regression analysis showed that female(OR=3.542),senior age(OR=3.51),low income((OR==1.465),living alone(OR=3.404),unable to take care of themselves(OR=3.295),suffering from multiple chronic diseases(0R=4.718),multiple medications(OR=2.309),urinary incontinence(OR=3.594),depression((OR=3.27),poor self-evaluation(OR=2.482)were the risk factors for frailty in Guangzhou.Regular physical exercise(OR=0.158)was a protective factor.3.Formulating a frailty management program:Literatures was systematically searched and 8 guidelines was included.Guidelines was evaluated by the the Reporting items for practice guidelines in healthcare(RIGHT).The report rate was high in the basic information,background,and evidence dimensions,but in the recommendation,review,and quality for guarantees funding and conflict of interest statements and management of other dimensions,reporting rates were low.The expert group was set up to interpret the clinical practice guidelines.Combining with the current medical conditions,a screening and management programme for the elderly in China was developed.4.Qualitative research results of programme applied in primary health care settings:Based on the Precede-proceed Model,barriers and facilitators from health care providers,managers and the elderly were analyzed.Facilitators factors included the willingness of the elderly to actively manage their health and the willingness of health care providers to take the program.Barriers included lack of knowledge,negative values of the elderly and their caregivers;health care providers respond that current institutional resources were insufficient and task assignments between teams were contradictory,communication and cooperation were difficult,they needed support for implementing the programme;managers reflected institutional human resources was insufficient,there was no incentive mechanism in primary care setting.CONCLUSIONS1.The Chinese version of SHARE-FI has good reliability and validity,and it can be implemented in primary health care settings with certain feasibility.2.The prevalence of frailty elderly people in Guangzhou is relatively high,which was affected by various risk factors.More attention was needed in the further.3.Based on evidence-based,the frailty screening and management programme was scientific and credible by applicability adaptation and expert argumentation.It can be used as a reference programme for frailty management in community-dwelling elderly.4.Frailty screening and management programme can be implemented in primary health care settings,but funding and resources was required from government,manager,communities and caregivers. |
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