De Luca, Vincenzo (2023) An IT-supported multidimensional approach to screen for frailty in community-dwelling older adults. [Tesi di dottorato]

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Abstract

The study aimed to design and validate a digitally supported frailty screening and prevention intervention in community-dwelling older adults, to integrate the biomedical paradigm of frailty with the "bio-psycho-social" paradigm, in order to take into account all the different factors that influence the individual's health towards frailty: environmental, physical, educational, socio-economic and psychological. The study took in consideration SUNFRAIL multidimensional frailty screening tool, which consists of only nine items, to generate alerts orienting subsequent diagnostic assessments for health promotion, disease prevention and targeted interventions. A literature review has been developed to identify further evaluation tools of bio-psycho-social frailty domains. The study selected 178 reviews, published between January 2010 and December 2021. Within the selected articles, 123 assessment tools were identified (polypharmacy 15; malnutrition 15; physical activity 25; medical visits 0; falls 26; cognitive decline 18; loneliness 9; social support 15; economic conditions 0) (133). A new service model for frailty screening of community-dwelling older adults has been developed through the SUNFRAIL+ platform, an IT tool that supports healthcare professionals by linking the items of the SUNFRAIL tool to additional scales aimed at assessing frailty domains and enabling the development of adequate intervention strategies. A national multi-centre observational study protocol has been designed to validate the approach by assessing the impact of early, integrated and multi-professional care on the quality of life of the community-dwelling older adult population and the professional’s satisfaction. The study is still underway in 8 centers coordinated by the Department of Public Health of Federico II University. 113 older adults were enrolled in the study at the Federico II University Hospital. Approximately 90% of the enrolled subjects have at least one frailty risk factor collected through the SUNFRAIL tool. The study showed that the most frequent risk factor is polypharmacy (47.8%), followed by a sedentary lifestyle (37.1%) and memory loss (32.7%). The preliminary data from the pilot study revealed that SUNFRAIL+ is able to describe in details an existing frailty; it is simple to use and characterized by a low expenditure of resources which would allow its widespread use throughout the territory, in order to intercept people at risk of frailty. The planned six-month follow-up will provide information on the impact of the model in terms of preventing negative outcomes. This would allow the patient to be guaranteed a better quality of life and at the same time reduce the demand for services paid by the National Health System.

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