A program to prevent functional decline in physically frail, elderly persons who live at home
Open accessAbstract
BACKGROUND: Functional decline in physically frail, elderly persons is associated with substantial morbidity. It is uncertain whether such functional decline can be prevented. METHODS: We randomly assigned 188 persons 75 years of age or older who were physically frail and living at home to undergo a six-month, home-based intervention program that included physical therapy and that focused primarily on improving underlying impairments in physical abilities, including balance, muscle strength, ability to transfer from one position to another, and mobility, or to undergo an educational program (as a control). The primary outcome was the change between base line and 3, 7, and 12 months in the score on a disability scale based on eight activities of daily living: walking, bathing, upper- and lower-body dressing, transferring from a chair, using the toilet, eating, and grooming. Scores on the scale ranged from 0 to 16, with higher scores indicating more severe disability. RESULTS: Participants in the intervention group had less functional decline over time, according to their disability scores, than participants in the control group. The disability scores in the intervention and control groups were 2.3 and 2.8, respectively, at base line; 2.0 and 3.6 at 7 months (P=0.008 for the comparison between the groups in the change from base line); and 2.7 and 4.2 at 12 months (P=0.02). The benefit of the intervention was observed among participants with moderate frailty but not those with severe frailty. The frequency of admission to a nursing home did not differ significantly between the intervention group and the control group (14 percent and 19 percent, respectively; P=0.37). CONCLUSIONS: A home-based program targeting underlying impairments in physical abilities can reduce the progression of functional decline among physically frail, elderly persons who live at home.
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The benefits of a structured exercise program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty.
“The benefits of a structured exercise program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty (76,77).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [77]
The Results and Discussion (page unavailable) report less functional decline and lower disability scores after a home-based intervention, chiefly among participants with moderate frailty. Walking was one component of the disability scale, but the paper does not establish prevention of mobility disability specifically. It does not report reduced sedentary time or reduced frailty, and the intervention was not the LIFE study. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOne RCT in 100 frail older people living in long-term care reported that nutritional supplementation had no effect on muscle strength, gait speed, stair climbing or physical activity.
“One RCT that investigated the effects of exercise and nutritional supplementation in 100 frail older people living in long-term care reported that nutritional supplementation had no effect on muscle strength, gait speed, stair climbing or physical activity (126).”
From Frailty in elderly people (2013) · cites this paper as [126]
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- Authors
- Gill, T. M., Baker, D. I., Gottschalk, M., Peduzzi, P. N., Allore, H., & Byers, A.
- Affiliations
- Yale University (US)
- Yale New Haven Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2002-10-03
- Volume
- 347
- Issue
- 14
- Pages
- 1068-1074
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1992899973
- Cited by
- 871
- References
- 34
- Citations by year
- 2026: 15 · 2025: 12 · 2024: 25 · 2023: 30 · 2022: 30 · 2021: 44 · 2020: 27 · 2019: 45 · 2018: 36 · 2017: 31 · 2016: 43 · 2015: 49 · 2014: 53 · 2013: 40 · 2012: 48
- FWCI
- 15.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Yale University
- National Institutes of Health (5k23ag000759-02)
- National Institute on Aging (K23AG00759, P60AG010469)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- functional decline, frailty, older adults, home-based intervention, physiotherapy, activities of daily living, balance, muscle strength, mobility (physical function), nursing home admission, disability prevention
- MeSH terms
- Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Female, Persons with Disabilities, Health Services for the Aged, Home Care Services, Humans, Male, Frail Elderly
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