A realist review to understand the efficacy and outcomes of European frailty interventions in the country, healthcare organisational and patient contexts.

The aim of this study was to compare, using a realist review approach, frailty intervention methods used across the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) with findings from literature reviews conducted as part of a larger study, known as FOCUS, supported by the European Commission. Results indicated that in the context of frail or pre-frail adults and tailored care or geriatric evaluation and management (GEM) interventions, neither hospital nor community delivery was more successful than the other. However, client centred participatory programmes worked well and those with a theoretical grounding in health psychology were particularly successful. In the healthcare organisational context, a lack of standardisation between health practitioners created a challenge to intervention success. Further, baseline differences in the quality and effectiveness of standard care between different countries, meant that the effects of GEM interventions were more pronounced in less wealthy countries. In the context of participant conditions, interventions worked well when: participants were frail or pre-frail but not disabled; when participants were from a lower SES or were less well educated; when participants had a positive affective reaction to the programme; when participants had choice or autonomy over intervention components, activities and timings; and when participants were involved in social or group activities which reduced isolation. It was recommended that initial frailty levels and full person contexts are included as components of intervention design, and strategies to enhance the social and psychological aspects of interventions are included even in physically focused interventions.