Addressing frailty for healthy ageing: GERI at the 9th Asian Conference for Frailty and Sarcopenia

Is Singapore frailty-ready? Are we on track to become frailty-resilient? What more can we do to address frailty as a public health priority, so that longer lives are lived well and not in poor health?

GERI faculty and researchers brought their insights to bear on these issues and more at the recent 9th Asian Conference for Frailty and Sarcopenia, an annual gathering of the field's leading thought leaders, clinicians and researchers.

Frailty as a priority in the healthy ageing agenda

In a conference highlight, our Joint Faculty member Associate Professor Lim Wee Shiong, Director, Institute of Geriatrics and Active Ageing and Senior Consultant, Department of Geriatric Medicine, Tan Tock Seng Hospital, delivered the plenary session on “Forging a Frailty-Resilient Health System". Associate Professor Lim's plenary charted the evolution of Singapore's healthcare approach to enable older adults to live and age healthily.

Speaking to GERI on the sidelines of the event, Associate Professor Lim commented, “Conventionally, when thinking about preventative approaches to address population ageing, attention has been placed on the evaluation and treatment of standalone chronic diseases. However, this contrasts with the multiple, interacting, and multi-dimensional issues affecting older persons.”

“Against this backdrop, frailty has emerged as a key public health priority due to its high prevalence, impact on the individual’s quality of life, and public health impact. The holistic approach towards frailty prevention and management, involving medical, functional, psychosocial and lifestyle factors, more aptly reflects the complexity of the multi-dimensional needs of older persons,” he said.

Elaborating on his plenary message for various policy and practice stakeholders to “unite” in the journey towards frailty-resilience, Associate Professor Lim acknowledged that there were “inherent organisational, structural and funding challenges” that still had to be addressed. Nonetheless, he pointed out progress made in the following areas:

1. A comprehensive agenda that addresses the frailty conundrum across its spectrum, from the robust/prefrail in the community through to the established frail in the healthcare system;

2. Ambition for integrated care models and approaches, such that impact at the level of public health can be scaled and sustained;

3. Alignment of identification measures, case definitions and evidence-based interventions for frailty; and

4. Multifaceted action. This includes public education and engagement on frailty, and efforts made to enhance research methodologies and evaluation approaches for complex real-world interventions.​

3 ‘P’s for closing the frailty research-to-practice gap 

“In terms of frailty management in Singapore, we need to progress from mere knowledge creation to practice and policy translation.” Our Executive Director, Associate Professor Ding Yew Yoong made this point during a wider panel discussion alongside regional experts, where he outlined three levels of action – from the systemic to the person-centered – to galvanise this translation process.

These potential levels of action comprise of:

1. Policy. According to Associate Professor Ding, clear policy direction and strong support for translation of research knowledge is needed. “In this respect, the function of programmes developed to target frailty should have common elements, while their form could be allowed to vary across different contexts. Supportive financing models are also needed to encourage programme development by implementers and the uptake of these interventions by older people," he said.

2. Practice. “We need to develop innovative frailty programmes and interventions, but just as importantly, the implementation and evaluation of such models of innovation also requires attention," noted Associate Professor Ding. To facilitate this, health and community systems should be collaborative learning environments. Integration with existing care processes is also important, including avoiding duplicative efforts, he added.

3. Person. At this level, Associate Professor Ding said, “Willingness on the part of older persons to participate in recommended activities, and family or peer support, are key factors for successful translation. To this end, improved frailty awareness together with better programme accessibility is needed."

GERI’s translational research to address frailty

The conference also featured three research projects by GERI and our collaborators, on various community and hospital-based interventions addressing frailty and mobility among older adults in Singapore.

Research Fellow Dr Tou Nien Xiang clinched the Gold award for his poster on the implementation of a community-based exercise intervention for frail older adults. The study by GERI and the Tsao Foundation focused on Baduanjin, a form of traditional Chinese Qigong exercise.​

“The evidence indicates that Baduanjin is an acceptable, feasible and safe exercise programme for community-dwelling frail older adults. Our study showed that this exercise intervention has the potential to be successfully implemented in active ageing centres in Singapore," said Dr Tou.

Dr Tou noted that its effectiveness on physical performance remains inconclusive. “Future research could further examine the effects of varying exercise volume on physical performance, as well as the longer-term effects of such low-intensity exercise interventions," he said.

Dr Melanie Tan, Adjunct Faculty member and Consultant, Geriatric Medicine, Ng Teng Fong Hospital, also participated in the poster presentation where she shared findings from the Help Optimise and Mobilise Elders (H.O.M.E) study, funded by GERI.

The study found that the physical function and gait speed of elderly patients increased after they underwent an inpatient programme designed to get them moving more frequently in the hospital ward. These findings could signa​l the potential for such intervention programmes to prevent functional decline amongst older adults who are hospitalised.

Elsewhere, Dr Tan Woan Shin, Joint Faculty, presented on the GERI-led evaluation of the Geriatric Services Hub (GSH), as part of the Conference Symposium on “Innovations in Care: Community". The GSH programme is aimed at providing early identification of frailty and offering comprehensive and coordinated care for frail older adults.

​In her talk, Dr Tan, the GSH project lead, discussed the enablers and constraints encountered by the programme implementers, as well as learning points, in delivering holistic and high-quality care for older adults in the community.

Congratulations to our faculty and researchers for a successful conference!​