FRAILTY REDUCTION VIA IMPLEMENTATION OF EXERCISE, NUTRITION AND DEPRESCRIBING (FRIEND) TRIAL: NOVEL IMPLEMENTATION OF THE ASIA-PACIFIC FRAILTY GUIDELINES IN AGED CARE

Abstract

Virtually all adults in aged care are frail, contributing to falls, cognitive decline, hospitalisation, and mortality. polypharmacy, malnutrition, sedentariness, and sarcopenia are risk factors amenable to intervention. Asia-Pacific Frailty treatment guidelines recommend anabolic exercise, medication and dietary optimisation. However, no study has evaluated this best practice intervention in aged care. AIM: Evaluate institutional translation of best-practice frailty treatment in aged care residents. The Frailty Reduction via Implementation of Exercise, Nutritional support and Deprescribing (FRIEND) trial (ANZCTR#:ACTRN12622000926730p) is a 6-month translational trial evaluating resident outcomes, staff/caregiver knowledge and institutional translation in a Townsville aged care facility. Residents received high-intensity resistance and balance training, medication and nutrition optimisation co-implemented by investigators (AEP, geriatrician, pharmacist, nutritionist) and facility staff. Staff and caregivers completed comprehensive education modules and training. We report resident outcomes for Phase-one (6 months exercise with staggered implementation of medication/nutritional arms) in preparation for full implementation (Phase-two). 29 residents (21 female, age:88.6±6.3yrs) were recruited. At baseline, residents were frail (FRAIL-NH;6.3±2.4/14), cognitively-impaired (MoCA;13.8±6.8/30), had low physical function/capacity (SPPB;4.9±3.1/12, 6MWT;222.2±104.4m) and numerous prescribed medications (15.5±5.9). Two residents died & one withdrew before intervention, and nine residents declined exercise intervention. Exercising residents’ adherence was 73.4±18.3% (28±7/38 sessions), with non-significant baseline differences compared to decliners (p>0.05). FRAIL-NH worsened significantly across the entire sample (0.93±1.87,p=.019), however this progression was attenuated in exercisers (0.71±1.83,p=0.35). Furthermore, clinically meaningful improvements in frailty (Fried phenotype;-0.73±1.09,p=.022), Leg press (median{IQR}:40.9%{26.5%)) and knee extension strength (median{IQR):61.9%(259%),p<0.001), 6MWD (35.4±45.8m,p=0.022;30m-MCID), Physical Function (SPPB;1.9±2.3,p=0.007;1-point MCID), and cognition (MoCA;1.31±3.4,p=.131;1.22-point MCID) were observed in exercisers. Only 1 minor exercise-related adverse event occurred. Six months of AEP-led high-intensity exercise with preliminary, staggered implementation of medication and nutrition optimisation in aged care improved frailty and risk factors in residents. Phase-two results following 6-months of full, concurrent implementation of exercise, medication and nutrition arms are anticipated May, 2024.