A Biopsychosocial Approach to Improving Multidimensional Frailty Status in Community-Dwelling Older Adults

Frailty is a prevalent clinical syndrome that is of growing concern with ageing populations worldwide. Frail individuals have an increased risk of unfavourable outcomes, including falls, disability, hospitalisation, and death. Recently, the conceptualisation of frailty has evolved from a simple concept to a complex, multidimensional biopsychosocial construct involving the physical, psychological, cognitive, and social domains. As frailty is dynamic and transitional, early interventions are worthwhile. However, clinical research into frailty has been hindered by a lack of consensus over its domains and a limited understanding of how its domains interact. It is crucial to define frailty as a multidimensional construct to reflect the negative physiological effects of medical, psychological, and social factors. However, recent studies of frailty have neither emphasised the interactions between different domains nor devised effective multidimensional interventions.

The biopsychosocial approach to medicine emphasises the importance of understanding the complete contexts of human health and illness, and considers biological, psychological, and social factors and their interplay when comprehending health, illness, and healthcare provision (Engel, 1977). As the applications of this biopsychosocial model to frailty interventions remain limited, intervention studies encompassing all biopsychosocial domains are needed. The proposed study will take the novel approach of treating frailty as a multidimensional biopsychosocial syndrome and using the integrated biopsychosocial framework to address the interrelated physical, psychological, and social domains together.

The study will be designed as a four-arm, double-blinded, cluster-randomised controlled trial. A sample (N = 308) of prefrail older adults aged 60–80 years will be recruited from 32 randomly selected elderly community centres in Hong Kong and classified into four frailty deficit patterns (multi-frailty, physical-to-psycho/social, nonphysical-to-psycho/social, and a robust control). With the hypothesised biopsychosocial framework pinpointing the intertwined relationships of these three domains of frailty, we will propose four intervention strategies (biological/psychosocial/nutritional, biological/nutritional, psychosocial/nutritional, and an inactive control) to improve their overall frailty, regarding their physical, psychological, and social functioning, nutritional status, and lifestyle changes in a 9- month intervention and follow-up period. Our primary objective will be to assess the effectiveness of the intervention strategies for improving the frailty status of participants in each of the four frailty deficit pattern groups, and to determine the most effective intervention strategy.

The novel multidimensional approach to frailty intervention will benefit participants’ frail status across bio-psycho-social domains. The findings will have practical implications for healthcare professionals, caregivers, and policymakers, leading to improved care and support for community-dwelling elder adults.