Intervention
dehydration, diabetes
DEHYDRATION, SESSION, DIABETES, MALNUTRITION
A multidisciplinary team comprising nurses, nutritionists, and physical educators conducted the educational intervention. The educational group received a 6-month health education program consisting of 4 group sessions and 6 follow-up calls, while the control group maintained their usual healthcare attendance.The 4 group sessions were conducted during the first month after the pre-test, with one session per week lasting approximately 45–60 min each. The educational sessions focused on the following topics: (1) frailty description and its impact on health, (2) guidelines for physical activity, (3) promoting healthy dietary habits, and (4) cognitive training and psychological and social well-being. Participants were encouraged to engage in debates and share their doubts and experiences. Each group session was limited to a maximum of 15 participants. If a participant was unable to attend a specific group session, another date with another group was scheduled to ensure a 100% attendance rate.The aim of session 1 was to raise awareness about frailty, its implications on health, and how it progresses with ageing. During this session, emphasis was placed on the varying degrees of frailty, introducing and clarifying the concept of pre-frailty. Additionally, the session briefly addressed risk and preventive factors related to frailty, which would be further detailed in subsequent sessions. This session was imparted by a registered nurse.Session 2 encompassed exercise recommendations for frail and pre-frail older adults, with a special emphasis on strength training in addition to the importance of aerobic exercise. The session highlighted the benefits of physical activity on health and quality of life to prevent the progression of frailty. Simple strength exercises that could be performed at home were demonstrated to improve muscle strength (e.g., squat to a chair or calf raises), along with guidance on exercises that should be avoided due to the risk of injury. Participants were provided with printed examples of exercises they could perform daily at home. Additionally, participants were encouraged to engage in physical and sports activities for older adults, either organized by private companies or the local municipality, while discouraging prolonged periods of sedentary behaviour. This session was performed by a sports scientist specialising in healthy physical exercise.The main objective of session 3 was to promote dietary habits that would help prevent caloric-protein malnutrition, dehydration, and an imbalanced diet among the participants. Therefore, the Mediterranean diet was advocated, with special emphasis on certain aspects relevant to frail older adults, such as the daily consumption of a source of animal protein. Participants were encouraged to incorporate probiotics (e.g., yoghurt) and prebiotics (e.g., some vegetables) into their diets, with an explanation of the intestinal microbiota and its relationship to health. Printed examples were also provided for reference. Moreover, when frailty coexisted with another condition in which diet has a significant impact, such as diabetes, concepts like the glycaemic index were also covered, illustrating which foods or culinary techniques can increase it. This session was performed by a registered nutritionist.Session 4 focused on the importance of cognitive training, psychological well-being, and social engagement. Participants performed some cognitive exercises and they were encouraged to incorporate them into their routines at least twice a week. These exercises included activities such as crosswords, word searches, Sudoku, personal diary writing, knitting or crocheting, painting, etc. Furthermore, they were motivated to engage in activities that pleased them, to recognize positive qualities within themselves, and to prioritize their mental well-being. Additionally, they were advised to participate in daily social activities to foster social engagement. This session was performed by a registered nurse.Following the completion of the initial 4 sessions (month 1), a follow-up was conducted in the intervention group through personal telephone interviews, totalling 6 calls: 2 calls in the second month (1 caLL every 2 weeks) and 1 caLL per month from the third to the sixth month. During these follow-up calls, participants were asked about their adherence to the provided recommendations, and they were encouraged to maintain those healthy lifestyles. Any doubts or concerns were addressed, and personalized solutions were provided when necessary.