One of the wonderful things about Ageing Well research is that we have had an opportunity to continue to investigate the same line of reasoning from one phase to another. This continuity of exploration into a topic provides greater depth of understanding and allows researchers to pursue topics that can have a direct impact on the lives of older people.
The phase 1 study ‘Retirement Villages’, led by Professor Martin Connolly from the University of Auckland, sought to understand more about these semi-closed communities and the needs of those residing in them. The research team wanted to find and help vulnerable residents with their health difficulties so as that they could stay well and avoid entry into hospital or aged care facilities.
This line of related investigation was continued by Dr Katherine Bloomfield, one of Professor Connolly’s research team members, in the Phase 2 funded study Frailty trajectories, resilience and quality of life (QoL) in the retirement village community: a vulnerable group.
The aim of this research was to investigate objective measures of frailty in older adults residing in retirement villages by developing and validating a frailty index from data collected by interRAI-Community Health Assessments. This continuity in research also enabled researchers to capitalise on relationships built with participants and village operators, and improved our understanding of the needs of those living in retirement villages.
The aim of this research was to investigate objective measures of frailty in older adults residing in retirement villages by developing and validating a frailty index.
The development of the Frailty Index tool
From the baseline data captured in the Phase 1 study, Dr Bloomfield’s team designed the Frailty Index tool to measure frailty in older people. They then repeated the interRAI assessment on all the original participants in order to show any changes in frailty. During these assessments, the team also measured participants’ quality of life and resilience with validated tools, and evaluated if the previously performed multidisciplinary team intervention had any effect on the repeat frailty score. Additionally, they looked at the relationship between frailty, quality of life, and resilience.
The project was innovative in three ways: it provided a new tool for health professionals to assess frailty; it’s the first study in Aotearoa to look at frailty changes within a particular population; and it is of the very few studies around the world that look at the interconnected strands of frailty, quality of life, and resilience.
About the project
The Frailty Trajectory study is a large New Zealand body of work assessing the health, functional and social needs of older people living in retirement villages, providing valuable information about this increasingly prevalent group of people. What the study discovered was that those who live in retirement villages have an average age of 82 years, and also have a high level of unmet needs (e.g., about 50% had cardiorespiratory symptoms and 48% with daily pain). Many residents had unplanned acute hospitalisations over the 2.5 years follow-up (53%), 11% moved to residential care, and 9% had died.
The research team identified that almost 20% of retirement village residents are moderate-to-severely frail and 45% are mildly frail. Frailty is a significant factor when assessing the needs of older residents. In the year before the baseline assessment, frailty was associated with hospitalisations, and also points to the increased risk of acute hospitalisations, entry to aged residential care, and death at the follow up assessment. For example, 79% of those who were moderate-to-severely frail had an unplanned hospitalisation over the follow-up period.
Some of the results obtained in this study illustrate some important findings which warrant further investigation and investigation, such as the potential value of retirement villages with on-site clinics, and the potential identification and intervention of the of very high risk (e.g. moderate-severely frail) to potentially reduce poor health outcomes.
The team’s research also showed there were few non-European residents residing in retirement villages. They identified potential issues of equity: not only in accessing retirement villages but also potentially also to the long-term care facilities many of these villages have on site. From this project, researcher Dr Joanna Hikaka received an HRC Research Activation Grant to address equity issues in the way Māori and non-Māori access residential aged care.
The Frailty Index could be applied to all people having an interRAI assessment, ideally leading to direct referral of those individuals with high frailty scores to a geriatrician/frailty team who could provide an individualized management plan.
The Frailty Trajectories study has potentially far-reaching impact. The Frailty Index could be applied to all people having an interRAI assessment, ideally leading to direct referral of those individuals with high frailty scores to a geriatrician/frailty team who could provide an individualized management plan. On an individual level, understanding where someone is on the frailty spectrum can help make decisions regarding interventions that carry significant risks (e.g. chemotherapy, surgery).
From a population standpoint, it would also allow frailty to be measured and compared across different parts of Aotearoa, so policymakers can develop appropriate infrastructure, funding, and support to areas with greater need. There is also potential for this to be explored further by private companies, such as village operators, allowing the companies to better understand the needs of their residents in different facilities (e.g. the need for an on-site health clinic).
The potential for internationalization is significant. As interRAI is used increasingly internationally, therefore using the Frailty Index would allow direct comparisons of frailty and frailty trajectories around the world. The research team has entered into a formal collaboration agreement with Dr Nancy Peele and Professor Ruth Hubbard from the University of Queensland, two highly respected academics with significant research experience in frailty. The collaboration will investigate and compare frailty in the populations in Australia and Aotearoa New Zealand.
Many study participants were very enthusiastic and expressed enjoyment in participating in this study, mostly for altruistic reasons. With such willing participants and targeted research, we now know much more about the lives of those living in retirement villages, their unmet needs, and ways to potentially improve their quality of life. This will help residents stay healthier for longer and avoid premature entry into aged care facilities.