The coronavirus disease 2019 (COVID-19) pandemic is keeping people apart, which can take a toll on physical and mental health. Many healthcare professionals are concerned vulnerable seniors may become deconditioned, which substantially increases risk of health complications and need for hospitalization. To address the immediate impact of COVID-19 policies (i.e., physical distancing, reduced access to care), the GERAS Frailty Rehabilitation model will be adapted to be delivered remotely in the homes of vulnerable seniors. The investigators' aim is to understand how to best build resilience among vulnerable seniors in the community through at-home rehabilitation services (socialization, exercise, nutrition, and medication support).
During this unprecedented time of COVID-19, many healthcare professionals are concerned that
vulnerable seniors who are housebound and isolated will become deconditioned resulting in
functional losses in mental status, continence and ability to complete activities of daily
living. Total inactivity in seniors can result in a 10-20% decrease in muscle strength per
week (1 -3% per day). Loss of muscle strength may quickly convert a vulnerable older adult
who was ambulatory into a bedridden state. This will affect the health of seniors and
increase demand on healthcare systems. An innovative model to deliver frailty rehabilitation
services remotely is urgently needed to: 1) increase access to specialized services 2)
provide added supports for seniors discharged from the hospital who are in need of
rehabilitation and 3) build resilience in seniors to prevent re-hospitalization or
institutionalization. Therefore, to address the immediate impact of COVID-19 policies (i.e.,
physical distancing and reduced access to care), the GERAS Frailty Rehabilitation model will
be adapted to be delivered remotely in the homes of vulnerable seniors. This
proof-of-concept, randomized control trial aims to understand how to best build resilience
among vulnerable seniors through at-home rehabilitation services using socialization,
exercise, nutrition, and medication support.
The short-term immediate goals for this RCT are to help vulnerable seniors who are isolated
because of physical distancing measures to build strength and resilience throughout the
COVID-19 pandemic. The major deliverables are 1) the adaptation of an in-person program to
virtual delivery 2) the piloting of a care pathway with inter-disciplinary professionals that
can be expanded to reach a larger number of individuals.
The long-term goal of the study is the seamless implementation of a new model for multimodal
Frailty Rehabilitation that closes the care gap in rehabilitation for frail seniors in the
immediate and foreseeable future.
Behavioral: Socialization
Social interaction is associated with better mental and physical health, and evidence suggests that group versus individual engagement may offer unique cognitive benefits for older adults as well as peer reinforcement and encouragement.
Behavioral: Virtual Group Exercise
Participants will receive twice-weekly (one hour per class) virtual exercise via small-group physiotherapy sessions for a total of 12 weeks. All exercise sessions will occur virtually via a videoconferencing system. The classes will focus on functional movements specifically designed for seniors with frailty and mobility challenges, and will include modifications for gait aids such as canes or walkers. Class sizes will be small to allow for tailoring of exercises based on challenging, safe, progressive, evidence-based exercises. In accordance with recent guidelines to achieve 3 hours/week for fall prevention practice in older adults, participants will also be provided with tailored supplemental home exercises developed by the study physiotherapist to gain an additional 1 hour of physical activity.
Combination Product: Nutrition Consult and Protein Supplementation
Nutrition Consult: Participants will be scheduled for a one-on-one virtual nutrition consult. During the consultation, study staff will assess the nutritional status of the participant and will provide them with counselling and coaching to improve their nutrition.
Protein Supplementation: Oral nutrition supplements commercially available from Nestle will be provided unless contraindicated. The oral nutrition supplement contains 360 calories and 14 grams of protein per serving. Participants are advised to take this with a meal or within 3 hours of exercise on activity days.
Behavioral: Medication Review
A study pharmacist will review the participant's medication list and will utilize Beers and/or START/STOPP criteria to provide recommendations to optimize/update their medications to the participant's healthcare provider. Study geriatricians will be listed as contacts on the primary care provider recommendations and available for consultation.
Inclusion Criteria:
- Community-dwelling adults aged ≥ 65 years of age;
- Score between 4-6 (inclusive) on the clinical frailty scale;
- Able to ambulate independently with or without a walking aid; OR with caregiver
supervision at home;
- Obtain clearance for exercise: For hospital referrals - average resting heart rate
between 50-100 bpm and average blood pressure less than or equal to 160/90mmHg (as per
Canadian Society for Exercise Physiology guidelines for exercise clearance); OR Self-
referrals: Obtain exercise clearance from their family physician prior to the first
intervention session.
Exclusion Criteria:
- Unable to speak or understand English and has no caregiver for translation;
- Significant cognitive impairment where they may have difficulty following two-step
commands;
- Receiving palliative/end of life care;
- Unstable angina or unstable heart failure;
- Travel plans that would result in missing greater than 20% of the trial's 12-week
duration;
- Currently attending a group exercise program.
McMaster University - Hamilton Health Sciences (St. Peter's Site)
Hamilton, Ontario, Canada
Alexandra Papaioannou, MD, MSc, Principal Investigator
Scientific Director, GERAS Centre for Aging Research