Health promotion for the elderly at risk of frailty: a scoping review

INTRODUCTION

The significant increase in the proportion of elderly people globally has increased the prevalence of people in a state of frailty, which presents challenges for public health.^1-3 Although there is still no consensus on its definition, frailty is characterized by the individual's vulnerability to endogenous and exogenous stressors, in which the elderly person becomes more vulnerable to adverse events such as dependence, falls, hospital admissions, and death.⁴

One study pointed out that the frailty phenotype consists of a clinical syndrome based on the identification of three of the five criteria: unintentional weight loss; self-reported exhaustion; reduced grip strength; reduced gait speed and low physical activity.⁵ In contrast, another study defended the multidimensional approach, which considers that psychological, physical, and social factors increase the frailty of the elderly.⁶

Pre-frailty appears as a transitional state between robust elderly people and frailty⁷. A longitudinal study showed that around 12% of elderly participants with pre-frailty worsened to frailty over a period of approximately four years. Thus, many pre-frail individuals are at risk of developing into frail.^7-8 However, frailty can be prevented or reduced through health promotion and disease prevention strategies.⁹

The need for immediate attention and the implementation of specific health tools and programs focused on promoting well-being and healthy aging is evident¹⁰. Due to the discreet production of studies focused on vulnerability in aging on the national scene, the project emerged as a basis for the development of research in the area of Gerontology, as part of the macro-project entitled: "Nursing and Comprehensive Health Care for the Elderly: health screening, vulnerabilities, demands and technologies for care", developed by the Gerontological Nursing Research and Studies Group (GNRSG).

This study is the first stage in the development of an educational technology to help expand strategies based on scientific evidence for health promotion and prevention.

OBJECTIVE

The aim was to map the available scientific evidence related to health promotion for older people at risk of frailty.

METHOD

This is a scoping review, carried out as proposed by the Joanna Briggs Institute (JBI), which is subdivided into the following phases: definition and alignment of research objectives and questions; development of inclusion criteria; elaboration and planning of the search strategy; selection of studies; data extraction; analysis; data mapping and summarization of results.^11-12

The research question was formulated following the Population, Concept, and Context (PCC) strategy,¹¹ which consisted of P - Elderly; C - Frailty; C - Health Promotion: "What are the interventions and strategies for promoting the health of elderly people at risk of frailty?"

The review was carried out in the following databases: Latin American and Caribbean Health Sciences Literature (LILACS) via the Virtual Health Library (VHL); Cumulative Index to Nursing and Allied Health Literature (CINAHL) via the Thomson Reuters main collection; Web of Science via the main collection (Clarivate Analytics); Scopus (Elsevier); National Center for Biotechnology Information (NCBI/PubMed); Excerpta Medica Database (EMBASE). References from the gray literature were searched using Google Scholar® and manual searches of reference lists, with the aim of identifying additional studies that were not found in the databases consulted.

The most varied methodological designs related to interventions and strategies/tools related to health promotion for the elderly at risk of frailty were included, with no language delimitation, from 2006 to 2022. The time limitation was in accordance with the approval of the National Health Promotion Policy, established by Ordinance MS/GM No. 687 of March 30, 2006.¹³ Exclusion criteria were studies carried out with people under the age of 60, studies focused on the elderly in hospital and institutionalized settings, and studies that did not answer the research question.

The search took place in September 2022, through remote access to the databases on the journal portal of the Coordination for the Improvement of Higher Education Personnel (CAPES), via the Federated Academic Community (CAFe). Through the research question, the following controlled descriptors were assigned: "Elderly"; "Health Promotion"; and "Frailty", identified in the Medical Subject Headings (MeSH), CINAHL Headings, Health Sciences Descriptors (DeCS) and Emtree (Embase subject headings), and non-controlled descriptors, in order to broaden the search strategy. The search was carried out in English, Portuguese, and Spanish for the VHL search and in English for the other databases.

The descriptors associated with each set of the PCC strategy were combined using the OR Boolean connector to obtain the additive combination. A restrictive combination was then obtained by intersecting the PCC strategy sets using the AND connector. The search strategy took into account the peculiarities of each database (Table 1). 

Table 1. Final search expression in the databases. Pesqueira (PE), Brazil, 2022.

LILACS via BVS	(MH: "Aged" OR  (Idosos) OR (Pessoa Idosa) OR (Pessoa de Idade) OR (Pessoas Idosas) OR (Pessoas de Idade) OR (População Idosa) OR (Idoso) OR (Aged) OR (Anciano) OR (personas añosas) OR (personas mayores) OR (Aged)  OR (Elderly) OR M01.060.116.100*) AND (MH: "Frailty" OR (Frailty) OR (Fragilidade) OR (Fragilité) OR (Debilidade) OR  (Síndrome da Fragilidade) OR (Debilidade) OR (síndrome del paciente frágil) OR (Frailties) OR (Frailness) OR (Frailty Syndrome) OR (Debility) OR (Debilities) OR (Frailty) OR C23.550.359*) AND (MH: "Health Promotion" OR (Health Promotion) OR (Promoção da Saúde) OR (Promoción de la Salud) OR (Ambientes Apoiadores de Saúde) OR (Ambientes de Apoio à Saúde) OR  (Campanhas de Saúde) OR (Item Promocional) OR (Itens Promocionais) OR (Programas de Bem-Estar) OR (Promoção do Bem Estar) OR (Promoção em Saúde) OR (ambientes de apoyo a la salud) OR (campañas de salud) OR (programas de bienestar) OR (ítem promocional) OR (ítems promocionales) OR (Promotion, Health) OR (Promotions, Health) OR (Promotion of Health) OR (Health Promotions) OR (Promotional Items) OR (Item, Promotional) OR (Items, Promotional) OR (Promotional Item) OR (Wellness Programs) OR (Program, Wellness) OR (Programs, Wellness) OR (Wellness Program) OR (Health Campaigns) OR (Campaign, Health) OR (Campaigns, Health) OR (Health Campaign) OR (Health Promotion) OR N02.421.726.407.579* OR SP2.840.385.522* OR VS1.001.004.001* OR I02.233.332.445*)
CINAHL via Thomson Reuters	(Aged OR Elderly ) AND ( Frailties OR Frailness OR Frailty Syndrome OR Debility OR Debilities OR Frailty ) AND ( Promotion, Health OR Promotions, Health OR Promotion of Health OR Health Promotions OR Promotional Items OR Item, Promotional OR Items, Promotional OR Promotional Item OR Wellness Programs OR Program, Wellness OR Programs, Wellness OR Wellness Program OR Health Campaigns OR Campaign, Health OR Campaigns, Health OR Health Campaign OR Health Promotion )
MEDLINE via PUBMED	(("Aged"[Mesh] OR (Aged) OR (Elderly)) AND ("Frailty"[Mesh] OR (Frailties) OR (Frailness) OR (Frailty Syndrome) OR (Debility) OR (Debilities) OR (Frailty)) AND ("Health Promotion"[Mesh] OR (Promotion, Health) OR (Promotions, Health) OR (Promotion of Health) OR (Health Promotions) OR (Promotional Items) OR (Item, Promotional) OR (Items, Promotional) OR (Promotional Item) OR (Wellness Programs) OR (Program, Wellness) OR (Programs, Wellness) OR (Wellness Program) OR (Health Campaigns) OR (Campaign, Health) OR (Campaigns, Health) OR (Health Campaign) OR (Health Promotion)))
Web Of Science via Clarivate Analytics	(Aged) OR (Elderly) and (Frailties) OR (Frailness) OR (Frailty Syndrome) OR (Debility) OR (Debilities) OR (Frailty) and (Promotion, Health) OR (Promotions, Health) OR (Promotion of Health) OR (Health Promotions) OR (Promotional Items) OR (Item, Promotional) OR (Items, Promotional) OR (Promotional Item) OR (Wellness Programs) OR (Program, Wellness) OR (Programs, Wellness) OR (Wellness Program) OR (Health Campaigns) OR (Campaign, Health) OR (Campaigns, Health) OR (Health Campaign) OR (Health Promotion
Scopus/ EMBASE via Elsevier	'aged'/exp OR 'aged patient' OR 'aged people' OR 'aged person' OR 'aged subject' OR 'elderly' OR 'elderly patient' OR 'elderly people' OR 'elderly person' OR 'elderly subject' OR 'senior citizen' OR 'senium' OR 'aged' AND 'frailty'/exp OR 'frailty' AND 'health Promotion'/exp OR 'healthy people 2010' OR 'healthy people programmes' OR 'healthy people programs' OR 'promotion, health' OR 'health promotion'

The study variables were: year; country of origin; study title; journal; language; type of study; interventions and strategies/tools used; study outcome; recommendations; multidimensional domain and study team. For the extraction and mapping of data from the included studies, the instrument adapted from the form recommended by the JBI¹² was used, structured in the R software. The selection of studies was carried out by three independent reviewers. To help with the storage, organization, identification of duplicate studies, and selection of articles, the references identified were imported into the Rayyan® application.¹⁴

In order to summarize the information and identify gaps in the literature, the data reduction method was used, which consisted of critical reading and classification of the results into conceptual categories.¹⁵ The review protocol was registered on the Open Science Framework (OSF) platform under DOI: 10.17605/OSF.IO/ZXAF9 and followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.¹⁶

The initial search yielded a sample of 2,683 studies: 834 from MEDLINE via PUBMED, 536 from EMBASE, 801 from Web of Science, 254 from SCOPUS, 140 from CINAHL, and 118 from LILACS. After excluding duplicates and the eligibility criteria, 63 studies were selected for full reading (Figure 1).

Figure 1. Flowchart of the study selection process, according to PRISMA. Pesqueira (PE), Brazil, 2022.

RESULTS

Of the 33 studies identified, 87.9% (n=29) were published in English. With regard to the countries in which the studies were carried out, Japan predominated, with 18.2% (n=6), followed by Sweden with 12.1% (n=4), Austria with 9.1% (n=3), Singapore with 9.1% (n=3) and Europe and North America with 6.1% (n=2). Regarding the types of studies, it was observed that the majority were Randomized Clinical Trials, with 39.4% (n=13), followed by pilot studies comprising 15.1% (n=5). 

It was observed that 69.7% (n=23) of the studies dealt with multidimensional interventions, 27.3% (n=9) focused on mobility, and 3% (n=1) on cognition. With regard to the interventions worked on, 51.5% (n=17) were group activities and 33.3% (n=11) were individual practices. Regarding the team involved in the research, 66.7% (n=22) were multi-professional researchers, 27.3% (n=9) were nurses, and 6% (n=2) were laypeople (Chart 2).

Table 2. Details of studies according to title, country of origin, year of publication, type of study, interventions carried out, strategies and tools used, and main results. Pesqueira (PE), Brazil, 2022.

TITLE	COUNTRY/YEAR/TYPE OF STUDY	ACTIONS - FOLLOW-UP PERIOD	MAIN RESULTS
INTERVENTIONS
The Influence of Intense Tai Chi Training on Physical Performance and Hemodynamic Outcomes in Transitionally Frail, Older Adults17	Georgia/ 2006/ Randomized	Lectures on fall prevention; exercise and balance - one year.	Significant changes in BMI, blood pressure, heart rate and posture.
Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomized three-armed controlled trial for "prefrail" people of 80+ years living at home18	Sweden/ 2010/ Experimental	Meetings and a preventive home visit about the aging process - three months.	Meetings are more effective than preventive home visits.
Health-Promoting Interventions for Persons Aged 80 and Older Are Successful in the Short Term—Results from the Randomized and Three-Armed Elderly Persons in the Risk Zone Study19	Sweden/ 2012/ Randomized controlled	Meetings and a preventive home visit about the aging process - three months.	Improved performance in pre-frail elderly in walking tests.
Changes in the physical functions of pre-frail elderly women after participation in a 1-year preventative exercise program20	Japan/ 2013/ Randomized	Preventive health classes with program and exercises - one year.	Improved performance in pre-frail elderly in walking tests.
Health Promotion Can Postpone Frailty: Results from the RCT Elderly Persons in the Risk Zone21	Sweden/ 2015/ Randomized controlled trial	Preventive home visits and weekly meetings on self-care, use of medication, technology, the aging process, and nutrition - three months.	Meetings proved more effective.
A randomized controlled trial of the effect of an intensive 1-year care management program on measures of health status in independent, community-living old elderly: the Eldercare project22	Canada/ 2015/ Randomized controlled trial	Home visits with the development of a care plan focused on healthy aging and the doctor's usual care - one year.	The home care program for healthy seniors had no impact on the outcomes measured.
Effects of a Home-Based and Volunteer-Administered Physical Training, Nutritional, and Social Support Program on Malnutrition and Frailty in Older Persons: A Randomized Controlled Trial23	Austria/ 2016/ Randomized controlled	Social group of home visits with social contact and cognitive stimulation and guidance program on physical exercise and nutrition - three months.	Lay-led home social support can help combat malnutrition and frailty in elderly people living in the community.
Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomized controlled trial24	Spain/ 2017/ Pilot study	Short illustrated leaflet with physical exercises to do at home and nutritional guidelines - one year.	May prevent progression to frailty.
Impact of a lay-led home-based intervention programme on quality of life in community-dwelling pre-frail and frail older adults: a randomized controlled trial25	Austria/ 2017/ Randomized	Home visits on nutritional guidelines and physical activity with specialists and social meetings with social interaction and cognitive activities carried out by lay people - three months.	The combined nutrition and exercise intervention did not lead to significant improvements in quality of life compared to social meetings.
Cognitive Effects of Multi-Domain Interventions Among Pre-Frail and Frail Community-Living Older Persons: Randomized Controlled Trial26	Singapore/ 2017/ Randomized controlled trial	Group and individual cognitive, physical, and nutritional interventions - six months.	Aerobic and resistance training was effective in processing speed, attention, and working memory.
The effectiveness of a coordinated preventive care approach for healthy aging (UHCE) among older persons in five European cities: A pre-post-controlled trial27	United Kingdom; Greece; Croatia; Netherlands; and Spain/ 2018/ Controlled	Care plan adapted to the preferences of the elderly - one year.	The care plan was effective in promoting quality of life.
A Community-Wide Intervention Trial for Preventing and Reducing Frailty Among Older Adults Living in Metropolitan Areas: Design and Baseline Survey for a Study Integrating Participatory Action Research with a Cluster Trial28	Japan/ 2018/ Cluster randomized	Community consultations aimed at improving dietary variety and physical and social activities - three years.	Effective in preventing frailty in the whole community.
Effect, process, and economic evaluation of a combined resistance exercise and diet intervention (ProMuscle in Practice) for community-dwelling older adults: design and methods of a randomized controlled trial29	Netherlands/ 2018/ Pilot study	Exercise training focusing on leg muscles and dietary guidelines - nine months.	Implementation and cost-effectiveness for reducing frailty.
Evaluation of processes and evaluation of results of frailty prevention measures centered on the Silver Human Resource Center in Yabu City, Hyogo Prefecture30	Japan/ 2019/ Randomized	Frailty prevention classes, with exercise, nutrition, and social programs - one year.	The risk of frailty was reduced.
Effects of a person-centered nursing intervention on Frailty in Pre-Frail Community Residents older adults31	South Korea/ 2020/ Quasi-experimental	Exercise training, nutritional and psychosocial interventions with face-to-face support, and regular telephone support - three months.	Improved grip strength, physical function, nutritional status, and reduced depressive symptoms.
Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population32	Croatia/ 2020/ Controlled	Training, workshops and activities on fall prevention and healthy ageing - one year.	Combined exercise and healthcare interventions have a positive effect on frailty.
Rationale and protocol of the StayFitLonger study: a multicenter trial to measure efficacy and adherence of a home-based computerized multidomain intervention in healthy older adults33	Switzerland, Canada and Belgium/ 2020/ Pilot study	App with physical and cognitive activities - six months.	Encourages physical and cognitive health associated with independent living at home.
Efficacy of multidomain interventions to improve physical frailty, depression and cognition: data from cluster-randomized controlled trials34	China/ 2020/ Cluster randomized	Group activities with physical, cognitive, and nutritional training and guidance on diseases prevalent in aging - one year.	Stimulates the main determinants of physical well-being and mental health among the elderly.
Frailty Intervention through Nutrition Education and Exercise (FINE). A Health Promotion Intervention to Prevent Frailty and Improve Frailty Status among Pre-Frail Elderly—A Study Protocol of a Cluster Randomized Controlled Trial35	Malaysia/ 2020/ Cluster randomized	Lectures and sessions on multicomponent exercises and nutritional education - three months.	Able to prevent frailty and the adverse effects associated with pre-frail elderly.
Description of participants in the “atout age mobility” prevention workshops at the university hospital center of la reunion: a prospective study36	France/ 2021/ Pilot study	Workshop with physical exercise sessions - three months.	Benefits of the multi-professional team in preventing frailty
Membership is more than just being present: example of a home program conducted by lay people with physical exercise, nutritional improvement and social support, in pre-frail and frail elderly community residents37	Austria/ 2021/ Randomized controlled trial	Home visits with interventions related to physical exercise, nutrition and social support carried out by lay people - six months.	Lay people can carry out interventions resulting in good adherence rates.
Effects of support programs for frailty prevention activities led by residents through community diagnosis using the community as a partner38	Japan/ 2021/ Cohort	Classes on the prevention of frailty, such as oral function, nutrition, and cognitive function - one year.	Practice of activities related to the prevention of frailty increased after the class.
The Singapore Geriatric Intervention Study to Reduce Cognitive Decline and Physical Frailty (SINGER): Study Design and Protocol39	Singapore/ 2022/ Pilot study	Digital workshops focusing on regular aerobic and strength exercises, adherence to diet, cognitive stimulation and vascular exercises, and home visits - two years.	Delayed cognitive decline.
Effects of a nurse-led multicomponent intervention for frail older adults living alone in a community: a quasi-experimental study40	South Korea/ 2022/ Controlled	Group interventions with exercise, cognitive training and education on nutrition and disease management - three months.	Multicomponent intervention led by nurses was effective for pre-frail and frail elderly.
STRATEGIES
A booklet on health promotion and longevity in the elderly41	Florida/ 2011/ Methodological	Booklet with preventive strategies to minimize functional limitations and increase longevity.	Physical activities and exercises, nutrition, chemoprophylaxis, accident prevention and immunization.
Multi-professional and multi-dimensional group education – a key to action in elderly persons42	Sweden/ 2012/ Observational	Meetings on healthy aging.	The multidimensional approach proved effective.
Evaluation of a long-term care prevention project by a compound program in one municipality43	Japan/ 2016/ Observational	Lectures on nutrition, oral hygiene, and gymnastics.	Improved eating and exercise habits.
Prevention of frailty in aging44	France/ 2017/ Methodological	Booklet on the prevention of frailty.	Non-pharmacological interventions combined with physical exercise and nutritional counseling improve quality of life.
Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis45	United Kingdom/ 2017/ Systematic review	Health promotion for community-dwelling older people with mild frailty or pre-frailty.	Group exercise interventions had positive effects.
A realist review to understand the efficacy and outcomes of interventions designed to minimize, reverse or prevent the progression of frailty46	United Kingdom/ 2017/ Systematic review	Group health education with nutritional activities, cognitive activities focused on memory, attention, executive function and information processing skills, physical exercise, with strength training, and functional capacity, including mobility and balance.	Reduction of frailty and transition from pre-frail to non-frail.
Promoção da saúde de idosos frágeis e em risco de fragilização47	Brazil/ 2019/ Integrative review	Home visits and educational meetings, nutritional assessment and supplementation, health maintenance programs, and cognitive training.	Home visits and educational meetings are effective.
Community-based peer-led intervention for healthy aging and evaluation of the ‘happy’ program48	Singapore/ 2021/ Observational	Digital program on physical, cognitive, and social activities.	Improved cognition, physical function, social network, falls, depression, and perceived health.
Effect of Ankle Weights as a Frailty Prevention Strategy in the Community-Dwelling Elderly: A Preliminary Report49	Japan/ 2022/ Observational	Lower limb muscle strengthening with ankle weights.	Strengthening the lower limbs with weights prevents the risk of falling and improves strength.

DISCUSSION

There has been an evolution over the years in health promotion interventions and strategies for older people at risk of frailty. The increase in the number of programs for health promotion interventions for this public is due to the increase in population aging,⁵⁰ which requires strategies and interventions to encourage healthy aging and enhance quality of life.

Most of the interventions carried out have had positive results in reducing and preventing frailty, which strengthens the scientific evidence base on health promotion for pre-frail elderly people. It was found that frailty can be avoided through early identification and prevention measures, in order to avoid unnecessary damage and costs and promote longevity.⁵¹ This justifies the scientific interest and the increase in evidence on the subject due to the consequences of frailty for society.

Most of the interventions dealt with activities related to physical exercise, cognitive training, and nutrition. It was found that physical exercise, both together and in isolation, was the most commonly used intervention for reducing frailty. According to the World Health Organization, physical activity is relevant to promoting healthy aging.⁵²

The use of physical activity and resistance training interventions has positive results in increasing lower limb strength and mobility in the elderly, reducing the rates of falls, hospitalization and frailty.⁵³ However, although physical exercise has been the most widely used modality, there is no evidence that it is more effective than other interventions.

Regarding cognitive training to improve pre-frailty, even with little evidence of high impact, when used in combination with other intervention domains, they were more effective in reducing cognitive decline and the progression of dementia.⁵⁴ It can be seen that multidimensional interventions may have potential in preventing and reducing frailty.

With regard to nutritional education, it has been shown that more than a third of pre-frail elderly people became robust again.⁵⁵ Thus, physical training interventions combined with nutritional education can be an effective strategy for promoting the health of the elderly.

In relation to multidimensional interventions, it was noted that multidomain approaches were more effective compared to the implementation of isolated interventions. Actions that encompass multidimensional aspects were able to improve functional capacity and reduce frailty, which favors quality of life for the elderly.⁵⁶ Therefore, more scientific evidence is needed to prove the effectiveness of this strategy. 

Among the educational interventions, lectures, meetings, home visits, and educational technologies were used. In four articles, educational meetings were more effective than home visits. However, individualized home-based exercise and nutrition interventions can reduce frailty and improve physical performance in the elderly.⁵⁷ It can therefore be considered that interventions with educational meetings worked in groups can be beneficial in stimulating socialization and the well-being of the elderly.

In interventions with lectures, it was shown that counseling programs with lectures were essential for changes in lifestyle habits and improvements in cognition and understanding of the topics covered.⁵⁸ Combined strategies of informative interventions and training can be effective in promoting healthy aging.

Another intervention used refers to the use of educational technologies, through booklets, leaflets, apps, and digital programs. The use of gerontechnologies has contributed to enhancing self-care and empowering the elderly⁵⁹, an essential tool in health promotion, as well as the broad potential for disseminating knowledge.

Concerning the research team, it was observed that most of the studies dealt with actions with a multi-professional team. Services with multidisciplinary teams were effective in improving the quality of life and well-being of the elderly.⁶⁰ We can reflect on the importance of multi-professional action for health promotion, which enhances comprehensive care.

In order to maximize the acceptance and use of health interventions, it is essential to consider the needs and individual capacities of the elderly.⁶¹ Therefore, in order to assess the effectiveness of the tool used, clinical studies are needed in different scenarios. In addition, in order to measure the effectiveness of actions during clinical practice, health professionals can routinely monitor elderly people using instruments that measure frailty, such as the Clinical Functional Vulnerability Index (CFVI-20), which enables multidimensional assessment to guide the care plan.⁶²

A limitation of this study is the scarcity of national studies on the subject, which highlights the need for scientific production to promote the health of the elderly at a national level.  It is believed that this review can encourage and support the creation of instruments that promote improvements in the health of older people at risk of frailty. It also provides information to enhance health professionals' knowledge and provide multidimensional care for the elderly.

CONCLUSION

The scientific evidence mapped on health promotion for elderly people at risk of frailty made it possible to identify the main interventions and strategies/tools used to prevent frailty. There was a predominance of studies that addressed practices focused on physical exercise, nutritional education, and cognitive stimulation, through the use of lectures, meetings, home visits, and educational technologies. The effectiveness of the multidimensional interventions carried out by the multi-professional team was observed, which had positive results in reducing and preventing frailty.

There has been progress in creating interventions and strategies to promote the health of elderly people at risk of frailty, due to the ageing population. The development of actions aimed at this public is an essential factor for changes in lifestyle habits, well-being as they age, and the prevention of frailty.

There is a need to develop studies on the health of elderly people at risk of frailty in various social contexts, in order to enhance comprehensive care and encourage healthy aging practices. It is pertinent to expand care in a transdisciplinary way, with the implementation of interventions and strategies that encompass the elderly person in their multidimensionality.

CONTRIBUTIONS

Conception and/or design of the study: Silva TJP, Silva CRD; Data collection, analysis and interpretation: Silva TJP, Silva CRD, Lima SSE; Writing and/or critical review of the manuscript: Silva TJP, Silva CRD; Approval of the final version to be published: Silva TJP, Silva CRD, Lima SSE, Carvalho KM, Sá GGM, Alcoforado JMSG.

CONFLICTS OF INTERESTS

Nothing to declare.

FUNDING

Foundation for the Support of Science and Technology of Pernambuco (FACEPE) and the Federal Institute of Education, Science and Technology of Pernambuco (IFPE).

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