Implementing a Successful Aging Intervention for Frailty​

The older adult population in the United States is rapidly growing. Approximately 10,000 people turn 65 every day in the USA. One of the most debilitating aspects of aging is the development of frailty that contributes to functional limitations and an increased risk for nursing home placement. We propose to develop a self-management intervention that can reduce frailty in older adults to facilitate their ability to age-in-place. The long-term objective of this work is to develop a package of multi-component frailty interventions that can be administered by physical therapists within health systems to expand the conventional access to and traditional physical therapist interventions. Our goal is to provide an ongoing source of access to physical therapist services, specifically to a population of older adults for whom traditional reimbursable physical therapist interventions may be limited. The specific goal of this proposal is to develop a self-management intervention to reduce frailty in older adults. Our specific aims are to: 1) develop a PT-led self management intervention via an interdisciplinary team with stakeholder input; 2) evaluate the feasibility of the intervention by assessing intervention program satisfaction and adherence rates; and 3) determine the effects of the self-management intervention through evaluating pre- to post test changes in frailty classification, self-rated health, self-efficacy, frailty knowledge, and healthcare utilization. Recently, Dr. Danilovich completed a 12 week resistance exercise research study with frail older adults. Considerable experience was gained from this project, specifically the need for interventions that provide ongoing, long-term self-management skills. Older adults with frailty face an undulating disease course, limited knowledge of and access to interventions, and high levels of health insecurity. Thus, a self-management intervention providing education and skill development in coping strategies, symptom management, physical activity, and use of health resources is critical to support the long-term, on-going health needs of frail older adults. Thus, we now propose to use an interdisciplinary stakeholder panel to develop a PT-led self-management intervention for frail older adults and assess its impact on frailty, symptom management and healthcare utilization. Through a novel interdisciplinary approach to intervention development, we will maximize expertise of all stakeholders to devise an intervention optimized for acceptability and successful implementation. This proposal will allow physical therapists to be at the forefront of the development and implementation of a self-management intervention for frailty. Importantly, our intervention will be designed so that it can be implemented by PTs through any clinic or healthcare environment, allowing this intervention to be readily scaled nationwide. Developing a self-management intervention through an interdisciplinary team provides a mechanism to disseminate a public health intervention with PTs serving as health promotion experts for a vulnerable population with limited access to traditional PT service. Furthermore, while evidence documents the effectiveness of self-management interventions for those with chronic conditions, it is unknown if self-management interventions can slow or reverse frailty status. This proposal will contribute important knowledge regarding the impact of a self-management intervention on frailty and results will inform the self-management instruction that physical therapists provide in best-practi