Strategies for implementing the interRAI home care frailty scale with home-delivered meal clients

Lisa A Juckett; Haley V Oliver; Govind Hariharan; Leah E Bunck; Andrea L Devier

doi:10.3389/fpubh.2023.1022735

Strategies for implementing the interRAI home care frailty scale with home-delivered meal clients

Front Public Health. 2023 Jan 23:11:1022735. doi: 10.3389/fpubh.2023.1022735. eCollection 2023.

Authors

Lisa A Juckett¹, Haley V Oliver¹, Govind Hariharan², Leah E Bunck³, Andrea L Devier³

Affiliations

¹ Occupational Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States.
² Coles College of Business, Kennesaw State University, Kennesaw, GA, United States.
³ Lifecare Alliance, Columbus, OH, United States.

Abstract

Introduction: Frailty is a complex condition that is highly associated with health decline and the loss of independence. Home-delivered meal programs are designed to provide older adults with health and nutritional support that can attenuate the risk of frailty. However, home-delivered meal agencies do not routinely assess frailty using standardized instruments, leading to uncertainty over the longitudinal impact of home-delivered meals on frailty levels. Considering this knowledge gap, this study aimed to facilitate home-delivered meal staff's implementation of a standardized frailty instrument with meal clients as part of routine programming. This article (a) describes the use of Implementation Mapping principles to develop strategies supporting frailty instrument implementation in one home-delivered meal agency and (b) examines the degree to which a combination of strategies influenced the feasibility of frailty instrument use by home-delivered meal staff at multiple time points.

Methods and materials: This retrospective observational study evaluated staff's implementation of the interRAI Home Care Frailty Scale (HCFS) with newly enrolled home-delivered meal clients at baseline-, 3-months, and 6-months. The process of implementing the HCFS was supported by five implementation strategies that were developed based on tenets of Implementation Mapping. Rates of implementation and reasons clients were lost to 3- and 6-month follow-up were evaluated using univariate analyses. Client-level data were also examined to identify demographic factors associated with attrition at both follow-up time points.

Results: Staff implemented the HCFS with 94.8% (n = 561) of eligible home-delivered meal clients at baseline. Of those clients with baseline HCFS data, staff implemented the follow-up HCFS with 43% of clients (n = 241) at 3-months and 18.0% of clients (n = 101) at 6-months. Insufficient client tracking and documentation procedures complicated staff's ability to complete the HCFS at follow-up time points.

Discussion: While the HCFS assesses important frailty domains that are relevant to home-delivered meal clients, its longitudinal implementation was complicated by several agency- and client-level factors that limited the extent to which the HCFS could be feasibly implemented over multiple time points. Future empirical studies are needed to design and test theoretically derived implementation strategies to support frailty instrument use in the home- and community-based service setting.

Keywords: evaluation; evidence-based practice; home-and community-based care and services; implementation science; knowledge translation; nutrition; pragmatic trials.

Publication types

Observational Study
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Forecasting
Frailty*
Home Care Services*
Humans
Meals
Retrospective Studies

Grants and funding

This project was supported, in part by grant number 90INNU0016, from the Administration for Community Living, U.S. Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.