A Interventional Study of Geriatric Frailty, Osteoporosis, and Depression

Frailty, osteoporosis, and depression are three highly prevalent geriatric syndromes. Having these conditions are associated with adverse outcome in physical health, mental health, quality of life, and daily functioning. They are associated with higher mortality rates as well as increased health care cost. Risk factors, pathogenesis, clinical phenotypes, and interventions of these three geriatric syndromes are often related. Multifactorial, interdisciplinary integrated care models may benefit more to patients with the above 3 geriatric syndromes than single intervention targeting single condition. The objective of this proposed study is to conduct a randomized control trial (RCT) to exam the effectiveness of integrated interventions on multiple outcomes among community-dwelling Taiwanese elders with high risks for frailty, osteoporosis, or depression.

Subjects are community-dwelling Taiwanese elders older than 65 years of age, living in the catchment area of Tofun Twon in Maoli County, Taiwan. Subjects are first screened with telephone interviews. Potential enrollees are invited to community hospitals in the catchment areas for second stage interviews. Subjects meeting criteria of "prefrailty or frailty"- the frailty group, "osteopenia or osteoporosis"- the osteoporosis group, and "sub-threshold depression or major depression"- the depression group are enrolled. Subjects are randomised into the "usual care group" or the "integrated care group" by study care managers with prespecified protocol.

Interventions in the "usual care group" and the "integrated care group" among subjects with three geriatric syndromes are described below:

"Usual care- frailty and osteoporosis group": Educational materials on general knowledge of the two syndromes are provided. Subjects are encouraged to have balanced nutrition, regular exercises or rehabilitations when appropriate. It is at the subjects' discretions to decide the intensities of interventions.

"Integrated care- frailty and osteoporosis group": The interdisciplinary geriatric care team (IGCT) will provide educational sessions on general knowledge of the two syndromes to subjects. The team will also assess nutritional needs, rehabilitation need, and exercise capacities of the subjects with personalized management strategies. Supervised rehabilitation/ exercise programs are also provided. If subjects do not improve on any of the 5 frailty indicators in 6 months, comprehensive geriatric assessments (CGA) are performed to look for other potential modifiable factors with appropriate interventions.

"Usual care- depression group": Educational materials of late-life depression are provided. Again, it is at the subjects' discretions to determine the intensities of their interventions.

"Integrated care- depression group": All subjects are referred to primary care physicians (PCPs). Treatment guidelines for the optimal management of late-life depression will be provided to the PCPs. Care managers in the IGCT will provide telephone counseling, education sessions to subjects and their caregivers. Care mangers will also coordinate their care with the PCPs and follow on the treatment effects. Treatments typically include antidepressants in subjects with major depressive disorder and antidepressants or omega-3 PUFAs in cases with sub-threshold depressions.

Subjects are community-dwelling Taiwanese elders older than 65 years of age, living in the catchment area of Tofun Twon in Maoli County, Taiwan.

• Frailty
• Osteoporosis
• Depression

• 1
  "Usual care- frailty and osteoporosis group": Educational materials on general knowledge of the two syndromes are provided. Subjects are encouraged to have balanced nutrition, regular exercises or rehabilitations when appropriate. It is at the subjects' discretions to decide the intensities of interventions.
• 2
  "Integrated care- frailty and osteoporosis group": The interdisciplinary geriatric care team (IGCT) will provide educational sessions on general knowledge of the two syndromes to subjects. The team will also assess nutritional needs, rehabilitation need, and exercise capacities of the subjects with personalized management strategies. Supervised rehabilitation/ exercise programs are also provided. If subjects do not improve on any of the 5 frailty indicators in 6 months, comprehensive geriatric assessments (CGA) are performed to look for other potential modifiable factors with appropriate interventions.
• 3
  "Usual care- depression group": Educational materials of late-life depression are provided. Again, it is at the subjects' discretions to determine the intensities of their interventions.
• 4
  "Integrated care- depression group": All subjects are referred to primary care physicians (PCPs). Treatment guidelines for the optimal management of late-life depression will be provided to the PCPs. Care managers in the IGCT will provide telephone counsellings, education sessions to subjects and their caregivers. Care mangers will also coordinate their care with the PCPs and follow on the treatment effects. Treatments typically include antidepressants in subjects with major depressive disorder and antidepressants or omega-3 PUFAs in cases with sub-threshold depressions.

Inclusion Criteria:

• 65 < Age < 80 years.
• living in the catchment area of Tofun Twon in Maoli County, Taiwan
• Patients with frailty
• Patients with osteoporosis
• Patients with depression

Exclusion Criteria:

-