Discussion
Frailty, malnutrition
MALNUTRITION
The main findings of this study underscore that older adults with pre-frailty or frailty who underwent a 6-month educational intervention experienced enhancements in their frailty outcomes, physical function, sleep patterns, and nutritional status when compared to the control group. These results highlight the potential of educational interventions in promoting a healthy ageing approach for this vulnerable population.Frailty is a significant concern in healthcare due to its impact on the longevity and quality of life of older populations (It is known that impaired physical function is a major indicator of frailty, compromising healthy ageing (Two systematic reviews have indicated that exercise and nutritional interventions may not be effective in improving the results of the tandem test and the sit-to-stand test in pre-frail and frail adults (Despite the significant improvements in physical function, our findings were not directly attributed to the levels of physical activity or inactivity measured by accelerometry over one week, neither in the unadjusted models nor in the adjusted models. Both the control and intervention groups maintained similar physical activity levels after 6 months. These results align with findings from previous studies (Previous studies have demonstrated that frailty is associated with a significant decrease in sleep quality (Nutritional habits and nutritional status are also essential factors in promoting healthy ageing and hold special relevance in the context of frailty (This study has several limitations that should be considered. Firstly, the study’s sample was limited to participants from the southern region of Spain, potentially restricting the generalizability of the findings to other populations or geographic areas. Furthermore, it’s crucial to note that the study’s results only reflect the outcomes of the educational intervention at the 6-month mark. To gain a more comprehensive understanding of the long-term effects and sustainability of these changes, conducting follow-up evaluations over an extended period would be valuable. Future studies should investigate whether these changes endure over time. Furthermore, it’s important to acknowledge that the control group was older and had more Fried’s criteria than the intervention group at the outset, which could potentially influence the results. However, it’s noteworthy that after six months, the results in the control group remained consistent, as well as the results after adjustin by these covariates This suggests that the differences observed between the two groups were not solely due to age or baseline frailty criteria but were likely influenced by the intervention itself. Nonetheless, despite the inclusion of some covariates in the analysis, it’s worth noting that other factors, such as economic status, which were not included, may also impact the results. This represents a limitation of the study. Another limitation relates to the assessment of malnutrition risk, which relied on interviewer questionnaires. This approach is susceptible to recall bias and may not accurately reflect participants’ actual behaviours. Additionally, the accelerometer used in the study was worn on the wrist and assessed sleep based on movement patterns rather than directly measuring sleep. Nonetheless, wrist-worn accelerometers are generally considered a minimally invasive method with good validity for assessing sleep behaviours in day-to-day life (Nonetheless, this study has several strengths. The FRAGSALUD program is an intervention easy to implement in the healthcare system, based on only 4 multitargeted sessions with phone calls as follow-up control during the subsequent months, making it an easy and useful tool for the healthcare system. In addition to this, frailty has been evaluated using different tools such as Fried’s questionnaire which focuses on both physical function and mental state, and SPPB evaluation which mainly focuses on physical frailty. Similarly, this study includes an integral evaluation of older adults, encompassing physical activity and sleep using more objective tools than questionnaires, nutritional assessment, physical function, and frailty.