Sustained improvement of intrinsic capacity in community-dwelling older adults: The +AGIL Barcelona multidomain program

• Published in: Journal of internal medicine Vol. 294; no. 6; pp. 730 - 742
• Main Authors: Ferrara, Maria Cristina, Pérez, Laura Mónica, Sole, Aida Ribera, Villa-García, Lorena, Ars, Joan, Soto-Bagaria, Luis, Bellelli, Giuseppe, Cesari, Matteo, Enfedaque, María Belén, Inzitari, Marco
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-12-2023
• Subjects: Adults; Aged; Aged, 80 and over; Aging; Cognitive ability; Critical point; Drug therapy; Empowerment; Exercise; Exercise Therapy - methods; Female; Frailty - diagnosis; Frailty - therapy; Geriatric Assessment - methods; Geriatrics; Guidelines; Health promotion; Humans; Hygiene; Independent Living; Male; Medicin och hälsovetenskap; Older people; Optimization; Primary care; Statistical analysis; Walking Speed; frailty; physical performance; integrated care; multidimensional; healthy ageing
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1111/joim.13710

Different programs promote healthy ageing through the optimization of intrinsic capacity. However, a major challenge is to assess their sustained effects over time. +AGIL Barcelona, a consolidated multidomain program, aims to optimize older adults' intrinsic capacity through a coordinated approach among primary care, geriatrics and community resources, in agreement with the integrated care for older people (ICOPE) guidelines. We aimed to evaluate the +AGIL Barcelona longitudinal effect on older adults' physical performance.
All +AGIL Barcelona consecutive participants since 2016 were enrolled. After a comprehensive geriatric assessment, a tailored, multidisciplinary intervention aligned with the ICOPE guidelines is offered. It includes a 10-week boost multicomponent exercise program, nutritional and sleep-hygiene counselling, revision and optimization of pharmacological treatments and screening for cognitive impairment, depression and loneliness. Changes in physical performance after 3 and 6 months were assessed using mixed models including baseline frailty degree, time and all potential significant confounders.
We included 194 participants in the analysis (mean age = 81.6 [standard deviation = 5.8], 68% women). An independent, clinically and statistically significant improvement in physical performance (Short Physical Performance Battery [SPPB] test, combining gait speed, strength and balance) was found at 3 months (SPPB mean change: 1.4; 95% CI: 1.1-1.6) and 6 months (SPPB mean change: 1.1; 95% CI 0.8-1.5). Equivalent results were observed for all the SPPB sub-tests.
A coordinated, multidisciplinary and integrated program can benefit older adults' intrinsic capacity. The participants' empowerment and the connection with the available community resources are critical points for a successful intervention.