A multi-domain intervention addressing the potential reversibility of cognitive frailty among community dwelling older persons of lower socioeconomic status

Abstract

There is currently no information regarding cognitive frailty (CF) status and its potential reversibility using a multi-domain intervention among community dwelling older persons of lower socioeconomic status (SES). The aim of this study was to determine the prevalence and associated factors of CF, develop a multi-domain intervention addressing its potential reversibility and to test its effectiveness among community dwelling older persons of lower SES in Klang Valley. In phase 1, 255 (68.58±5.67 years) community dwelling older persons participated. Prevalence of CF was 38.4%. Poorer immediate verbal memory [Rey Auditory Verbal Learning Test (RAVLT)], poorer attention [Digit Span (DS), poorer functional status (Instrumental Activities of Daily Living), and poorer health related quality of life for ‘usual activity’ were associated factors associated with CF (p<0.05). Phase 2 was the development of the ‘WE-RISE™’ multi-domain intervention comprising of multi-component exercise, cognitive stimulation, dietary counselling, and psychosocial support. Phase 3-Part 1 was a randomized controlled trial testing the effectiveness of the WE-RISE™ intervention in reversing CF conducted over 24-weeks (12-weeks instructed community-based and 12-weeks of WE-RISE@Home) and determining its cost. Significant intervention effects were observed for cognitive status [Mini Mental State Examination (η2p:0.237,p<0.001), RAVLT (η2p :0.212, p<0.001), DS (η2p: 0.193, p<0.001), Trails Making Test-A (η2p: 0.122, p<0.01)]; physical status [2-Minute Step Test (η2p: 0.253, p<0.001), 30-Chair Stand Test (η2p: 0.113, p<0.001), Timed Up and Go (η2p: 0.089, p<0.01)] and nutritional status [fat % (η2p: 0.077, p<0.05), muscle mass (η2p: 0.110, p<0.01), total body water % (η2p: 0.081, p<0.05), bone mass (η2p: 0.155, p<0.001), Basal Metabolic Rate (kJ) (η2p: 0.135, p<0.05), metabolic age (η2p: 0.355, p<0.001), pyridoxine (η2p: 0.071, p<0.001)]. Significant effects were also demonstrated in disability measures, some domains for health-related quality of life and exercise selfefficacy (p<0.05). The WE-RISE™ intervention cost was RM396.74/participant/48- sessions over 24 weeks (RM4.06/session). At 12th and 24th week, 74.1% and 63% of the participants in the experimental group respectively were no longer cognitively frail as compared to 10.7% and 3.6% in control group (p<0.001). In phase 3 part 2, physical activity, psychological well-being, and coping strategies were compared between the groups in WE-RISE™ trial during the COVID-19 Movement Control Order. The experimental compared to the control group had significantly higher levels of estimated resting energy expenditure (MET) for walking, moderate activity, total physical activity, were more independent in functional activities, had higher perceived meaningful life and feeling respected (p<0.05). Regarding coping, the experimental relied on religion and planning, while the control group relied on humour (p<0.05). In conclusion, CF is prevalent among community dwelling older persons of lower SES. The WE-RISE™ intervention has the potential in addressing reversibility of CF at lower cost as compared to hospital provided services, and participants of the intervention were more physically active with preserved psychosocial well-being during the COVID-19 pandemic. The findings of this study could be benchmarked for future studies targeting the prevention or reversal of CF among older persons