Frailty Is an Important Factor in Clinical Interventions for Older Adults, According to New Research From VillageMD
A new study published in the Journal of General Internal Medicine found that the efficacy of clinical interventions often varied by frailty levels, demonstrating that frailty is an important factor to consider in recommending treatments in older adults. The research was conducted by a team including members from the VillageMD Research Institute and is titled, "Frailty as an Effect Modifier in Randomized Controlled Trials: A Systematic Review." Researchers summarized the impact of patients' frailty status on the effectiveness of pharmacological, non-pharmacological, and multicomponent clinical interventions. This study is the first systematic review of evidence for the clinical community.
"This research is an important tool for clinicians in optimizing and individualizing treatments for patients," said Dr. Tom Cornwell, national medical director of VillageMD and a leading expert in home care, having conducted more than 34,000 home care visits in his 30-year career. "Caring for patients who have frailty is a delicate balance. A common misconception is that frailty causes decreased treatment efficacy, leading to under-treatment. Conversely, for frail patients near the end-of-life, efficacy and goals of care are important to consider to avoid over-treatment."
Frailty is a clinical state of reduced physiologic reserve and increased vulnerability to poor health outcomes, with adverse events including falls, dementia, and disability. In the United States, 15% of older adults are frail and 45% are pre-frail, according to the journal article "Frailty in Older Adults: A Nationally Representative Profile in the United States."
Over the course of the two-year project, the research team evaluated 61 randomized control trials that stratified participants by frailty and conducted an interaction effect or subgroup analysis of frailty and the intervention. In determining if frailty modified intervention effects, researchers found that:
- The effect of several pharmacological interventions (e.g., edoxaban, sacubitril/valsartan, prasugrel, and chemotherapy) varied according to the degree of frailty, whereas other treatments (e.g., antihypertensives, vaccinations, osteoporosis medications, and androgen medications) demonstrated consistent benefits across different frailty levels.
- Some non-pharmacological interventions had greater benefits in patients with higher (e.g., chair yoga, functional walking, physical rehabilitation, and higher dose exercise program) or lower (e.g., intensive lifestyle intervention, psychosocial intervention) levels of frailty, while others (e.g., resistance-type exercise training, moderate-intensive physical activity, walking and nutrition or walking) produced similar intervention effects.
- Specific combined interventions (e.g., hospital-based disease management programs) demonstrated inconsistent effects across different frailty levels.
"We need more studies to understand which treatment works and how treatment benefits and harms vary by patients' frailty level. A validated frailty instrument should be included in randomized controlled trials enrolling older adults to facilitate generation of high-quality evidence. This evidence is essential to tailor interventions that prevent over- or under-treatment in older adults, especially for frail patients," said senior research team member, Dr. Dae Hyun Kim, an Associate Scientist at Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and an Associate Professor of Medicine at Harvard Medical School.
In addition to caring for patients in practices, at home and virtually, Village Medical providers also identify patients who need additional advanced care support through its specialized, outpatient Stay Well Care Plan ? Advanced program.
About VillageMD
VillageMD provides high-quality, accessible health care services for individuals and communities across the United States, with primary, multi-specialty, and urgent care providers serving patients in traditional clinic settings, in patients' homes and online appointments. Committed to serving all patients and working with all payers, VillageMD consistently innovates value-based care, bringing integrated applications, population insights and staffing expertise to its owned and affiliate practices, ensuring high-quality care, better patient outcomes and a reduction in the total cost of care. Through Village Medical, Village Medical at Home, Summit Health, CityMD and other practices, VillageMD serves millions of patients throughout their lives, wherever and whenever they need care. To learn more, please visit www.villageMD.com.
About VillageMD Research Institute
The VillageMD Research Institute is dedicated to generating, curating, and disseminating evidence of value-based care. Its mission is to improve health outcomes, lower costs, and enhance the patient and provider experience through rigorous research.
News published on and distributed by:
