Supplementary Material for: Enhancing Frailty Status and Health-Related Quality of Life in Community-Dwelling Frail Older Adults

Introduction: Frailty poses a significant concern among older adults residing in the community, impacting their health and quality of life. This study investigated the effectiveness of the FANS in addressing frailty and enhancing health-related quality of life. The study aimed to evaluate the effects of a 6-month FANS on frailty status and health-related quality of life in community-dwelling frail older adults, and to compare the effects on fall efficacy, pain intensity, daily activities, stages of physical activity and nutrition behavior change, and satisfaction following the intervention. Methods: A quasi-experimental design was used to assess the FANS among frail older adults. The intervention, based on the Transtheoretical Model, was conducted in a mixed setting, combining in-person sessions held at a community care center and remote group care delivered through the LINE app. The experimental group (n=43) received the FANS intervention, while the control group (n=38) continued with standard health promotion activities provided at the same community care center. Intention-to-treat analysis evaluated the intervention's impact. Measurements were taken before the intervention and at the 3-month and 6-month marks to assess changes in frailty status, health-related quality of life, fall efficacy, pain intensity, and daily activities. Behavior change stages and satisfaction were monitored using the Fitness and Nutrition for Seniors Behavior Change Stages and Satisfaction Scale. Results: Within the experimental group, significant improvements were observed over time across multiple measures, indicating intra-group effects, including frailty, overall health-related quality of life, fall efficacy, pain intensity, and daily activities. Between-group effects demonstrated statistically significant differences in daily activities. Time and group effects showed statistically significant improvements in frailty at three months and six months post-intervention. Following the intervention, a substantial percentage of participants in the experimental group progressed in behavior change stages related to physical activity and diet, with 83.72% in the action and maintenance stages for physical activity behavior change and 81.40% in those for dietary behavior change. The overall satisfaction rating for the program was 9.25 ± 0.24. Conclusion: The FANS is a feasible and innovative community health promotion initiative tailored specifically for frail older adults residing in the community, particularly during a pandemic. This program has demonstrated significant improvements in frailty status, health-related quality of life, fall efficacy, pain intensity, and daily activities among community-dwelling frail older adults. Moreover, the program has facilitated notable advancements in behavior change stages, supporting community-dwelling frail older adults in adopting and maintaining healthy behaviors effectively.

引言：对于社区居住的老年人群体而言，衰弱是一项不容忽视的健康问题，会对其健康状况与生活质量造成不利影响。本研究旨在探究老年人健身与营养干预方案（FANS）在改善衰弱状况、提升健康相关生活质量方面的有效性。本研究的核心目标为：评估为期6个月的FANS干预对社区居住衰弱老年人的衰弱状态及健康相关生活质量的影响，并对比该干预在跌倒效能、疼痛强度、日常活动能力、身体活动阶段、营养行为改变以及干预后满意度方面的作用效果。

方法：本研究采用类实验设计，针对衰弱老年人开展FANS干预效果评估。本次干预以跨理论模型（Transtheoretical Model）为理论基础，实施场景兼具线下与线上形式：线下活动在社区护理中心开展，线上团体护理则通过LINE应用程序进行。实验组（n=43）接受FANS干预，对照组（n=38）则继续参与同一社区护理中心提供的标准健康促进活动。本研究采用意向性治疗分析（intention-to-treat analysis）评估干预的影响，并在干预前、干预后3个月及6个月三个时间点开展测量，以评估衰弱状态、健康相关生活质量、跌倒效能、疼痛强度及日常活动能力的变化情况。行为改变阶段与满意度采用老年人健身与营养行为改变阶段及满意度量表（Fitness and Nutrition for Seniors Behavior Change Stages and Satisfaction Scale）进行监测。

结果：实验组内多项指标随时间推移均出现显著改善，体现出组内效应，包括衰弱状况、整体健康相关生活质量、跌倒效能、疼痛强度及日常活动能力。组间效应分析显示，日常活动能力指标存在统计学意义上的显著组间差异。时间与组别的交互效应分析表明，干预后3个月及6个月时，衰弱状态均出现统计学意义上的显著改善。干预结束后，实验组中有相当比例的参与者在身体活动与饮食相关的行为改变阶段取得了进展：其中83.72%的参与者处于身体活动行为改变的行动与维持阶段，81.40%的参与者处于饮食行为改变的行动与维持阶段。本次项目的总体满意度评分为9.25±0.24。

结论：FANS是一项针对社区居住衰弱老年人的可行且具有创新性的社区健康促进方案，尤其适用于疫情期间。该方案已被证实可显著改善社区居住衰弱老年人的衰弱状态、健康相关生活质量、跌倒效能、疼痛强度及日常活动能力。此外，该方案还有效推动了行为改变阶段的进展，助力社区居住衰弱老年人更好地采纳并维持健康行为。