Heather Fritz works to prevent frailty in African Americans
A raw egg is frail. Lace is frail. A new relationship can be frail. Each of these is delicate and easily damaged. An older adult can also be frail, diagnosed with conditions that greatly increase their chance of injury and even death. Once a person is identified as frail, it can be difficult to rehabilitate him or her out of frailty.
But there is hope. Before a person becomes frail, they are pre-frail, as evidenced by changes in physical and mental health, socialization, and quality of life that make them likely to become frail within three to seven years. “If we can intervene at this point,” said Heather Fritz, assistant professor of occupational therapy (OT) and gerontology at Wayne State University, “we could possibly delay the descent into frailty.”
Fritz has won a $256,000 grant from the Michigan Health Endowment Fund to test an occupational therapy based intervention on 150 pre-frail African Americans. Her team is halfway through their two-year time frame and seeing positive results in the 75 people enrolled so far. “Patient satisfaction has been very high. They are telling us it is very useful,” Fritz said. “Even when they don’t do exactly what we ask them to do, they seem to be receiving good benefits.”
Doctors at Detroit’s Rosa Parks Clinic screen patients 55 and older for pre-frail symptoms. Potential enrollees learn about pre-frailty and why it’s important to stave off frailty as long as possible. “Most of the people we talked to had never heard about frailty before, never had a health care provider explain it to them,” Fritz said. “They had no idea how serious it could be.”
Once enrolled in the study, patients receive four visits from an OT over four months. Each visit “takes as long as it takes,” according to Fritz. “We don’t rush anyone. Many of our patients say, ‘You guys actually take the time to talk to me.’ We think that’s the way it should be.”
Visit #1 – A comprehensive OT evaluation that can take up to two hours, including medication management, activities of daily living, pain management, home safety and sexual satisfaction. The person’s strength, balance and range of motion are tested. The OT notes any special home care equipment in use. The visit takes place in the clinic or in the home, whichever is more convenient for the patient.
Visits #2 and #3 – The focus is either physical activity or diet, as selected by the patient. If it’s physical, the OT reviews any physical deficits uncovered in Visit #1 and prescribes a tailored home exercise program to alleviate them. If it’s diet, to reduce cholesterol for example, the patient learns about food choices and substitutions. Recommendations are highly personalized to the person’s abilities, needs and motivation.
The OT works with the patient to set small, achievable goals linked to an environmental trigger. If you want to replace butter with olive oil, you write it down and then take the butter off the counter and put a carafe of oil in its place. The same approach would apply to replacing salt with a salt-free seasoning mix. “We use the principals of habit formation: make specific changes to the environment to help support goals,” Fritz said.
Visit #4 – The last session is a wrap-up to talk through goals that have not been achieved and create new goals if needed. Since patients are being asked to make lifestyle changes, the OT tries to establish a long-term maintenance plan. Small changes consistently enforced can improve health.
Three and six months after the last visit, the patient is evaluated for any decreases in their original indicators of pre-frailty. Two and three years later, Fritz’s team will examine their medical records to see if they have moved into frailty. “It’s hard to measure something not happening,” Fritz said, “but pushing back the descent into frailty for a few years is a good start.”
Is it feasible?
Fritz wants to ensure this approach is feasible not only with patients but also providers and insurers. Her team will analyze costs and benefits to determine whether the program’s expenses can be reimbursed by insurance carriers to make it self-sustainable. She thinks the OT approach to frailty is a good fit. “OTs are trained to address issues of diet, physical activity, pain management, social interaction, balance, falls and safety – everything this plan requires. We could become the one-stop-shop for preventing frailty.”
Frailty is a significant cause of health care issues and personal suffering in later life and much harder to reverse than pre-frailty, yet almost no current programs target pre-frail persons. “Frailty can be slowed or reversed if we catch it soon enough and have the wherewithal to do something,” Fritz said. “We must develop programs to prevent frailty progression on a national scale, because soon we won’t have the resources to care for all our frail older adults. Let’s help them now rather than pay for it ten-fold later.”