Ns. Anung Ahadi Pradana., M.Kep., Sp. Kep. Kom. Ph.D. Pengarang

Abstract Title of Dissertation: Multidimensional Frailty Among Older Adults in Indonesia: From Assessment to Management Institution: International Ph.D. Program in Gerontology and Long-Term Care, Taipei Medical University Author: Anung Ahadi Pradana Advisor: Shu-Chun Lee, Associate Professor, International Ph.D. Program in Gerontology and Long-Term Care, Taipei Medical University Introduction: Frailty, traditionally viewed as a unidimensional construct characterized by physical decline, is now recognized as a multidimensional condition encompassing physical, psychological, and social domains, necessitating a multidisciplinary approach. Globally, frailty prevalence is highest in Australia & Oceania (31%), with Asia at 23%, while Southeast Asia, including Indonesia (26.8% and 55.5% for frailty and pre-frailty) shows significant rates. The financial burden associated with frailty among older adults can exert significant strain on both the affected individuals and their families, potentially leading to broader negative implications for household well-being and public health systems. This evolving understanding highlights the need for comprehensive assessment tools and interventions to address the multifaceted nature of frailty in older adults. The aims of this study were to provide a comprehensive depiction of multidimensional frailty in Indonesia through investigating the prevalence of frailty, conducting a psychometric evaluation a multidimensional frailty assessment tool, and investigate the feasibility of implementing the VIVIFRAIL intervention among older adults in Indonesia. Method: Study 1: This study aimed to estimate the prevalence of frailty among older adults in Indonesia through a meta-analytic approach, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across six electronic databases from November to February 2023. All peer-reviewed articles reporting prevalence data on frailty among Indonesian older adults (aged ≥ 60 years) were considered eligible for inclusion. Study 2: This study aimed to translate and psychometrically validate the Tilburg Frailty Indicator (TFI) into the Indonesian language. A total of 308 community-dwelling older adults in Indonesia participated in the study. Study 3: This study was designed as a randomised-controlled, single-blinded, and prospective study. It was conducted from July to September 2024 among Indonesian older adults residing in nursing homes. In this study, the VIVIFRAIL intervention consisted of a multicomponent exercise program conducted 5 days per week over 12 consecutive weeks. Exercise programs were tailored according to each participant’s functional capacity, categorized into four groups: severe limitation or disability (Group A), moderate limitation or frailty (Group B), slight limitation or prefrailty (Group C), and robust (Group D). The experimental and control groups comprised 10 participants each from Groups A, B, C, and D. Results: Study 1: The aggregated prevalence of frailty and prefrailty was found to be 37.9% and 44.8% in nursing home settings, 26.3% and 61.4% in hospital-based populations, and 21.1% and 59.6% among community-dwelling older adults, respectively. Additionally, pooled estimates based on assessment tools revealed frailty and prefrailty prevalence rates of 21.6% and 64.3% using the Frailty Index-40, 18.7% and 62.0% with the FRAIL scale, and 27.8% and 59.8% using the Fried Frailty Phenotype. Study 2: The TFI-I demonstrated satisfactory internal consistency (Cronbach’s α = 0.775) and excellent test–retest reliability (intraclass correlation coefficient = 0.94). Strong correlations were observed between the physical, psychological, and social domains of the TFI-I and corresponding constructs measured by established instruments, including the Short Physical Performance Battery (p < .001), Fried Frailty Phenotype (p < .001), Geriatric Depression Scale (p < .001), and the WHO Quality of Life Scale (p = .041), supporting its robust construct validity. Study 3: This study achieving a recruitment rate of 100%, an adherence rate of 100%, and a compliance rate of 100%. The attrition rate was 7.5%, while motivation and satisfaction rates were 86% and 87%, respectively. Analysis of primary and secondary outcomes revealed significant improvements in frailty status, physical performance, cognitive functions, independence in ADL, and overall quality of life. Conclusions: This study demonstrating promising results in relation to multidimensional frailty among the Indonesian population. This study provides valuable insights for policymakers and healthcare professionals regarding the current state of frailty, as well as assessment tools and interventions that have proven effective in preventing multidimensional frailty. Keywords: Indonesia, Multidimensional frailty, Older adults, Prevalence, Tilburg Frailty Indicator, VIVIFRAIL.