Wednesday    16:45-18:00    S2.8        Odin

Towards a new approach of frailty in later life

Chair: An-Sofie Smetcoren

Discussant: G.A.Rixt Zijlstra

Traditionally, frailty is viewed as a unidimensional concept focusing on physical problems older people encounter. Gradually, more innovative and broader definitions have been put forward including other domains of life. In order to provide proactive care and support so that older people can age well in place, attention is needed for the prevention of frailty among older adults. Therefore, over the years several initiatives have been implemented to proactively identify frail older adults, using various instruments and approaches such as ‘preventive home visits’, ‘identification of frailty in primary care’, and ‘multidimensional geriatric assessment’. The objective of this symposium – with presenters from Belgium and the Netherlands- is to provide insights into experiences with early detection and interventions in (frail) older adults, and underlines the importance of a multidimensional approach to frailty with a strong focus on empowerment. The presenters also wish to take in account a critical reflection at future priorities when researching frailty in later life.

S2.8.1 New theoretical perspectives on frailty: focus on prevention and empowerment

An-Sofie Smetcoren¹, Nico De Witte^{1, 2}, Liesbeth De Donder¹, Eva Dierckx¹, Sarah Dury¹, D-SCOPE Consortium

¹ Vrije Universiteit Brussel, Belgium, ² University College Ghent, Belgium

This theoretical paper argues that in order to explain, detect and prevent more effectively frailty in older adults, a better conceptualisation of what can be understood by this phenomenon is required. Following recent developments in population ageing, the authors argue that within the field of social gerontology frailty should be approached from a multidisciplinary perspective (bio-physical, cognitive, psychological, social, and environmental). When taken in account this multidimensional approach it is reasonable to assume that not every state of frailty has negative consequences in daily life. However, at present most frailty models are one-dimensional based and have largely focused on the registration of deficits and dependency. Within the light of Active Ageing there needs to be a registration of autonomy, competences and present formal and informal care and support. Therefore, it is proposed that the development of a dynamic, so-called frailty balance model is of high value, which includes the complex interplay of assets (e.g. social resources, coping, resilience, care giver) and deficits (e.g. physical, social, psychological and environmental frailty). This paper will comprehensively report on the progress of the research project ‘Detection - Support and Care of Older people: Prevention and Empowerment” (D-SCOPE). The main aim of the project is to easily, accurately and timely detect and prevent an older persons’ negative frailty balance. In doing so, the project renounces the deficit model and focuses on the competence model.

S2.8.2 What is the prevalence of cognitive frailty, and what is its association with other

frailty domains?

Anne Van der Vorst¹, Ellen De Roeck^{2, 3}, Sebastiaan Engelborghs, G.A.Rixt Zijlstra¹, Eva Dierckx³, D-SCOPE Consortium

¹ Maastricht University, the Netherlands, ² University of Antwerp, Belgium, ³ Vrije Universiteit Brussel, Belgium, ⁴Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA), Belgium

Background: Cognitive frailty is a relatively new construct. Little is known about its prevalence and possible associations with other domains of frailty. This study examined the prevalence of cognitive frailty and its association with environmental, physical, psychological and social frailty in three samples of older people with different levels of cognitive functioning. Methods: Cross-sectional data, including the Comprehensive Frailty Assessment Instrument – Plus (CFAI-Plus), was obtained from 521 community-dwelling older people aged 60 years and over, including a random sample of the general population (n=353), a sample of people at risk for multidimensional frailty (n=95), and a sample of people consulting a memory clinic (n=73). Overall cognitive functioning was assessed with the Montreal Cognitive Assessment Instrument. Descriptive statistics and linear regression models were conducted. Results: Prevalence rates of cognitive frailty increased with increasing cognitive dysfunctioning: 35.1%, 51.6% and 82.2%, respectively. Psychological and cognitive frailty were strongly and significantly associated, irrespective of the actual level of cognitive functioning. In the general population, cognitive frailty was significantly associated with physical and social frailty as well, whilst in the population at risk for frailty, cognitive frailty was significantly associated with psychological and social frailty. Conclusion: For intervention purposes, it seems important to assess different domains of frailty, adapted to the specificity of the population. For example, in more vulnerable populations, a focus on cognitive, psychological, and social frailty seems particularly important.

S2.8.3 Detection of (pre-)frail older people at municipality level: Increasing effectiveness

by using evidence-based risk profiles

Sarah Dury, Liesbeth De Donder, Eva Dierckx, An-Sofie Smetcoren

Vrije Universiteit Brussel, Belgium

Background: In order to detect individuals that are at risk for frailty, there is a need to detect these people timely. This paper investigates risk profiles of frailty among older people from a holistic view. Frailty is not only perceived as a physical decline but also as an emotional, social, environmental, and cognitive problem. In order to detect older people that are in need of care and support and may be frail, risk profiles need to be developed and tested within society. Methods: In a first phase, data from the Belgian Ageing Studies, a cross-sectional study among home-dwelling older people (N= 28,049) were analysed using multivariate regression models. Findings indicated several sociodemographic and socioeconomic risk profiles for frailty (domains). In a second phase, these risk profiles have been validated in three municipalities in Belgium. Samples were drawn from the population registers based on the detected risk characteristics. Results: The results demonstrated the effectiveness and efficiency of using these risk profiles among 872 older people living self-reliantly at home. Moreover, they helped determine domain-specific frailty profiles for the diverse group of older people. More insight is gained on the risk profiles for each specific domain of frailty in order to provide accurate case finding, to target resources among individuals or groups that are more at risk than others, and to make proactive care and support possible. In the discussion, this presentation elaborates on practical implications to use these profiles in the detection and prevention of frailty.

S2.8.4 Informal care as balancing factor for mastery of frail community-dwelling older

adults

Deborah Lambotte, Liesbeth De Donder, Martinus J.M. Kardol

Vrije Universiteit Brussel, Belgium

Background: This contribution examines how community-dwelling older care recipients experience the role of their informal caregivers in maintaining mastery over the care process. Frail older care recipients are often approached as individuals at risk for decreased mastery. This contribution however acknowledges different authors’ relational approach of mastery, and define mastery as a moral competence which takes place in relations to others. Methods: 65 qualitative in-depth interviews with community-dwelling older adults from the D-SCOPE project are analysed. These interviews were conducted in 2016 in the Dutch speaking part of Belgium and Brussels. The interviews were subject of thematic (content) analyses. Results: The results indicate that within the care process, informal caregivers stimulate and contribute to frail older adults’ mastery in various ways. This differ across the different dimensions of the care process (attentiveness, responsibility, competence, responsiveness). However, older adults sometimes experience losses in mastery as informal caregivers do not understand their care needs and do not involve older adults in the decision-making and organisation of care. Conclusion: This presentation will discuss why we need to acknowledge a relational dimension of mastery in frail community-dwelling older care recipients.