The Effect of Health Promotion Comprehensive Education Intervention on the Frailty Levels of Elderly Family Caregivers

While the decline in fertility rates all over the world has led to a demographic transformation, improved living conditions and technological advances have contributed to the prolongation of human life span and the increase in the number of elderly individuals. In parallel with the increase in the number of elderly people in the total population, the need for care is also increasing with long-term chronic diseases that require high-cost, complex technological intervention and care. Individuals in need of care and family caregivers prefer home care instead of institutional care for both cultural reasons and because the individual feels more autonomous at home. Therefore, the number of family members providing care at home is increasing.

Caring for family members is a stressful and time-consuming process and family caregivers are the primary caregivers of older adults. The challenges and burden of care vary depending on the circumstances and are also related to the caregiver's adaptation to the care process. The resulting maladjustment can lead to inadequate rest, interrupted sleep, chronic fatigue, economic hardship and depression, preventing the individual from meeting their own needs. Particularly if the care recipient has a cognitive impairment, the attention and time required to manage the individual's memory and behavioral issues may leave the caregiver with little time to attend to their own health needs and may neglect or delay their own care. In addition, family caregivers themselves are often elderly, chronically ill and at high risk of illness, in part due to lifestyle habits shared with the patient. All this can put caregivers at risk for emotional and physical problems and increase the susceptibility of older caregivers to health problems and frailty, a geriatric syndrome. Therefore, awareness of the risks associated with frailty, early identification and appropriate interventions can contribute to protecting and maintaining the health of this group.

The World Health Organization (WHO) has conceptually defined frailty as "a clinically recognizable condition in which older people have an increased ability to cope with daily or acute stressors due to age-related declines in physiological reserves and the functioning of multiple organ systems". Depending on the decrease in homeostatic reserves, the frailty process can be considered in three stages from non-frail to frail. These can be leveled as pre-frailty, frailty and the process of experiencing complications of frailty. Pre-frailty or fragility is clinically silent and most amenable to correction through interventions. Frailty, on the other hand, is a process in which available reserves are rapidly depleted, leading to rapid functional deterioration from well-being. The process of frailty complications can be described as an irreversible vicious circle leading to death. Although frailty has been misinterpreted in some studies as a pre-disease state that defines the end of life, the first epidemiologic data on transitions between frailty stages were reported by Gill et al (2006). Based on a 4.5-year longitudinal study of 754 older adults aged 70 years and older. In a 5-year longitudinal study of 754 older adults aged 70 years and older, it was found that 58% of participants made at least one transition between any two of the three frailty states at three follow-up visits 18 months apart, and that this transition occurred in about one-third of all visits, with participants moving from more advanced frailty states to less frailty states. This suggests that although advancing age increases the risk of frailty in individuals, frailty is not an inevitable consequence of ageing, nor is frailty an irreversible process or an inevitable path to death.

Although there is no gold standard for detecting frailty, multiple frailty screening tools have been developed and used for risk assessment and epidemiologic study. Therefore, the results of studies on the prevalence of frailty vary according to the age range, population, scale and measurement criteria used. In Europe, Eggiman et al. (2009) measured the prevalence of frailty in the same age group within the SHARE project and found the prevalence of frailty to be 17.0% and the pre-frailty rate to be 42.3%. Based on the studies in the literature, frailty risk factors can be categorized under four main headings: socio-demographic factors, lifestyle factors, medical risk factors and biological factors.

Socio-demographic factors include age, gender, ethnicity, education, low socio-economic status, living alone and loneliness, while medical risk factors include chronic diseases, multimorbidity, obesity, malnutrition, weight loss, impaired cognition, depressive symptoms and polypharmacy. Lifestyle-related risk factors include physical inactivity, diet, smoking and alcohol use. Biological risk factors include immune and neuroendocrine dysregulation, sarcopenia and energy imbalances/oxidative stress. For many individuals, the negative effects of these risk factors can be slowed down, stopped or even rapidly reversed with evidence-based early interventions for lifestyle and medical risk factors. Especially the avoidance of risky behaviors and healthy lifestyle behaviors that the individual performs with the support and awareness he/she receives have a significant contribution to the prevention of diseases and promotion of health. In the literature, there are many evidence-based studies on smoking, healthy eating, physical activity and immunization.