Active ageing and volunteering: a "match made in heaven" to counter frailty in older adults?
Frailty: a major burden that affects quality of life of older adults
Frailty is a complex geriatric syndrome that results from a multisystem reduction in reserve capacity. It is characterized by a state of increased vulnerability at higher age. Older adults, who become frail, are exposed to higher risks of adverse health outcomes such as falls, hospitalization, diminished mobility, increasing disability in activities of daily living and ultimately premature death, compared to their robust counterparts.1 Consequently, frailty and the tremendous impact it has on one’s health, conjointly affect health-care expenditure and use.2 Strategies to slow the progression of frailty are paramount!
Physical activity: the most effective frailty intervention but frail people are not active!
First-line therapy for the management of frailty includes a multi-component physical activity program with a resistance-based training component.3 Indeed, physical activity is the most effective intervention in decreasing frailty. Based on a recent network meta-analysis of 21 randomised controlled trials, physical activity is associated with a decrease in frailty compared to placebo or usual care (SMD -0.92, 95% CI -1.55, -0.29).4 Besides, physical activity increases the quality of life and is the second most effective intervention to improve cognition and lower depression in older adults.4
Despite the evidence of these beneficial effects of physical activity, frail people are not active! The prevalence of physical activity not only decreases dramatically with older age5 but frail older adults are even less physically active than their robust counterparts!6 Indeed, only 7% of frail older adults meet the recommendations for physical activity of the World Health Organisation (WHO).6 Hence, there is plenty of room for improvement!
Should we train non-professional volunteers to provide physical activity interventions?
The mere process of including frail older adults in exercise programs has provided many initiators with numerous challenges. Individual preferences and constraints related to the physical environment are considered important facilitators and barriers to implement exercise programs for frail older adults.7 Therefore, minimizing the environmental constraints such as eliminating the need for transport to a training facility has been suggested to lower the threshold to initiate and continue physical activity interventions. Also, the ‘Vlaams Instituut Gezond Leven’ (VIGL) - a non-profit expert-partner of the Flemish government that focusses on healthy living and health promotion in Flanders - recommends to take into account a trusty environment and recognizable faces (preferably family, friends, neighbours or caregivers) when investing in active ageing.8 Importantly, this recommendation resulted from a co-creation project (‘Gezond ouder worden’) with older adults.8 Also, the ‘Flemish Council of the Elderly’ (Vlaamse Ouderenraad) specifically recommends to train non-professional volunteers to counter frailty in lonely older adults.9 In addition, scientific evidence shows that physical training which is administered by trained lay nonprofessional volunteers is feasible and can help to tackle frailty in older persons living at home.10 Although further studies are needed to confirm these findings, implementing volunteers is a promising train of thought to break down some of the persistent barriers for initiating and continuing physical activity in frail older adults.
David Beckwée
References and further reading:
1.Vermeiren S, Vella-Azzopardi R, Beckwee D, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc 2016; 17(12): 1163 e1- e17.
2. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet 2019; 394(10206): 1365-75.
3. Dent E, Morley JE, Cruz-Jentoft AJ, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. The journal of nutrition, health & aging 2019; 23(9): 771-87.
4. Negm AM, Kennedy CC, Thabane L, et al. Management of Frailty: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. J Am Med Dir Assoc 2019; 20(10): 1190-8.
5. Bauman A, Merom D, Bull FC, Buchner DM, Fiatarone Singh MA. Updating the Evidence for Physical Activity: Summative Reviews of the Epidemiological Evidence, Prevalence, and Interventions to Promote "Active Aging". Gerontologist 2016; 56 Suppl 2: S268-80.
6. Kehler DS, Theou O. The impact of physical activity and sedentary behaviors on frailty levels. Mechanisms of ageing and development 2019; 180: 29-41.
7. Baert V, Gorus E, Mets T, Geerts C, Bautmans I. Motivators and barriers for physical activity in the oldest old: a systematic review. Ageing Res Rev 2011; 10(4): 464-74.
8. Vlaams Instituut Gezond ouder worden. 2020. https://www.gezondleven.be/projecten/gezond-ouder-worden (accessed 2020/02/05.
9. Van Acker R, Ouderenraad V. Samen sterk voor ouderen in beweging: in de vrije tijd inclusief sport, thuis, tijdens verplaatsingen en op het (vrijwillers)werk. Brussel: Vlaams Instituut Gezond Leven; 2018. p. 72.
10. Luger E, Dorner TE, Haider S, Kapan A, Lackinger C, Schindler K. Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial. J Am Med Dir Assoc 2016; 17(7): 671.e9-.e16.