Frailty Screening In The Community Elders And Construction Of Health Intervention Model For Frailty Elders

ObjectivesTo explore the prevalence and factors associated with frailty among urban community-dwelling elders;And analysis the relationship between frailty status,activity of daily living,geriatric depression,social support,cognitive function and quality of life;To explore the characteristics of experience of frailty elders to supplement information by qualitative research;To develop a intervention model for frailty elders in community and provide empirical basis for the elderly in long-term care plan.Methods1.Using mixed methods design which is give priority to with quantitative research and the complementary of qualitative research method to collect data.A quantitative study was conducted and questionnaire were sent to 544 community-dwelling elders.The instruments include the self-designed demographic questionnaire,Activity of Daily Living Scale(ADLs),Short Form Geriatric Depression Scale(GDS-15),Mini-mental State Examination(MMSE),Social Support Rating Scale(SSRS)and The Medical Outcomes Study 36-Item Short-Form Health Survey(SF-36)to measure activity of daily living,geriatric depression,social support,cognitive function and quality of life.Data were processed Using the SPSS20.0 software.A logistic regression analysis was performed to examine factors of frailty.Pearson correlations were used to examine the relationship between frailty status,activity of daily living,geriatric depression,social support,cognitive function and SF-36.The qualitative research by using semi-structured in depth interview was conducted in 12 frailty elders.Using interpretative phenomenological analysis to explore the characteristics of experience of frailty elders.2.An initial health intervention model of frailty elders in community was developed based on quantitative research and qualitative research.Results1.Quantitative research results: Firstly,The prevalence of pre-frailty and frailty were 41.9% and 13.8%,respectively.The prevalence of pre-frailty is highest during the age of 70-79 years old.Secondly,Risk factors associated with frailty include:age,number of comorbidity,the chronic diseases(coronary heart disease,diabetes mellitus,musculosk-eletal diseases),ADL,geriatric depression and cognitive function.Protective factors were degree of education,annual household income and quality of sleep.That is those who were older,had more comorbidities,chronic diseases(coronary heart disease,diabetes mellitus,musculoskeletal diseases)and poor ability of ADL,depression,and poor cognitive function were more likely to frail,but those who had better education,better economic conditions and high quality of sleep were not likely to frail.Thirdly,frailty were positively correlated with ADL and geriatric depression(r=0.593,0.426,P<0.01),negatively correlated with social support,cognitive function and quality of life(r=-0.130,-0.206,-0.535,P<0.05).There were statistically significantly differences of ADL,geriatric depression,cognitive function and SF-36(P<0.05)between different frailty groups,but no statistically significantly difference of social support.Fourthly,Structural equation modeling analysis showed that frailty directly negative effects SF-36(effect values are-0.14),meanwhile frailty indirectly effects SF-36 through ADL and depression(effect values are-0.503 and-0.21).Social support directly negative effects frailty(effect values are-0.161),meanwhile frailty acts as a partial mediator in the relationship between social support and SF-36.2.Qualitative research results,the characteristics of experience of frailty elders can be summarized as three stages,that is acceptance stage,coping stage and expecting stage.3.Based on the qualitative and quantitative research results,an initial health intervention model of frailty elders in community was developed.Conclusions1.The prevalence of frailty was higher than other places and the prevalence of pre-frailty was highest in the age of 70 to 79 among community-dwelling elders.2.The frailty status is influenced by multiple correlated variables.We should pay more attention to those elderly with older age,more comorbidities and chronic diseases(coronary heart disease,diabetes mellitus,musculoskeletal diseases),poor ability of ADL,depression and cognitive impairment,then give intervention to prevent or delay the frailty.3.Frailty was positively correlated with ADL and geriatric depression,negatively correlated with social support,cognitive function and quality of life,there were statistically significantly differences between frailty status and ADL,geriatric depression,cognitive function,SF-36.Frailty directly effects SF-36,meanwhile it indirectly effects SF-36 through ADL and depression.Social support negative effects directly on frailty,meanwhile frailty acts as a partial mediator in the relationship between social support and SF-36.4.We can prevent or delay the frailty by enhancing the activity of daily living,improving symptoms of depression and increasing social support,and effective management of chronic illnesses and cognitive intervention and so on.5.The characteristic of experience of frailty elders includes,acceptance stage,coping stage and expecting stage.6.An initial health intervention model of frail elders in community was developed,which can provide theoretical basis for the intervention for community-dwelling frail elderly.