Multifactorial Investigations Based on Comprehensive Geriatric Assessment (CGA)

A randomised trial of a multifactorial intervention based explicitly on CGA (medication adjustment, exercise, nutritional support, rehabilitation, social worker consultation and speciality referral) in 310 frail older men and measured using the Fried frailty criteria showed those who received CGA were less likely to deteriorate, but this was not significant (OR = 1.19, 95 % confidence interval=0.48-3.04, p=0.71).

The Frailty Intervention Trial (FIT) was established to provide a multidisciplinary, multifaceted intervention that specifically targeted individually identified components of the Fried frailty criteria (weight loss, weakness, exhaustion, slowness, and low activity) [113]. It comprised 241 older people identified as frail (positive for three or more of the Fried criteria) and randomised to the intervention or usual healthcare. The intervention was delivered by a multidisciplinary team led by a geriatrician and was akin to CGA. At 12 months there was a lower prevalence of frailty in the intervention group and a reduction in the number of Fried criteria by an average of 0.80 (SD = 1.19) in the intervention group compared with 0.41 (SD = 1.02) in the control group [114]. Adherence to the interventions was the significant limitation (median adherence to each interventions was only 50 %), reflecting the difficulties inherent to the implementation of multifactorial interventions in the real world.

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