Interventions for Cognitive Frailty: developing a Delphi consensus with multidisciplinary and multisectoral experts

Carol Holland^1,2*Nikolett Dravecz^1,2Susan Broughton^2,3Lynne Ann Barker⁴Fidelia Bature⁵Charlotte Clarke⁶Isaac M Danat⁷Sayani Das⁸Irundika Dias⁹Annabel Dawson¹⁰A Dawson¹¹Amanda Ellison¹²David Facal¹³Roland Finch¹⁰Christopher James Gaffney^14,2Alan J Gow¹⁵Eirini Kelaiditi¹⁶Andrzej Klimczuk¹⁷Esperanza Navarro-Pardo¹⁸Pheobe Sharratt^14,2Andrew Sixsmith¹⁹Claudia Kimie Suemoto²⁰Lalu Suprawesta²¹Tamlyn Watermeyer²²Sally Fowler Davis²³

• ¹Division of Health Research, Lancaster University, Lancaster, United Kingdom
• ²Centre for Ageing Research, Faculty of Health and Medicine, Lancaster University, Lancaster, England, United Kingdom
• ³Division of Biomedical and Life Sciences, Lancaster University, Lancaster, United Kingdom
• ⁴Sheffield Institute of Social Science, College of Social Science and Art, Sheffield Hallam University, Sheffield, England, United Kingdom
• ⁵Institute of Health Research, University of Bedfordshire, Luton, East of England, United Kingdom
• ⁶Wolfson Institute for Health & Wellbeing, Durham University, Durham, England, United Kingdom
• ⁷Sheffield Institute of Social Sciences, College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, England, United Kingdom
• ⁸Department of Social Work, Bar-Ilan University, Ramat Gan, Tel Aviv District, Israel
• ⁹Aston Medical School and Aston Research Centre for Health in Ageing, Aston University, Birmingham, West Midlands, United Kingdom
• ¹⁰Lay Contributor, Newcastle, United Kingdom
• ¹¹Northern Health Science Alliance, Manchester, United Kingdom
• ¹²Department of Psychology, Durham University, Durham, England, United Kingdom
• ¹³Department of Developmental and Educational Psychology, and Institute of Psychology, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
• ¹⁴Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, England, United Kingdom
• ¹⁵Department of Psychology, Heriot-Watt University, Edinburgh, Scotland, United Kingdom
• ¹⁶Faculty of Sport, Technology and Health Sciences, St Mary's University, Twickenham, Twickenham, London, United Kingdom
• ¹⁷SGH, Warsaw School of Economics, Warsaw, Masovian, Poland
• ¹⁸Department of Developmental and Educational Psychology, University of Valencia, Valencia, Valencian Community, Spain
• ¹⁹STAR Institute, Dept. of Gerontology, Simon Fraser University, Burnaby, British Columbia, Canada
• ²⁰Division of Geriatrics, University of São Paulo, São Carlos, São Carlos, São Paulo, Brazil
• ²¹Taipei Medical University, Taipei, Taipei County, Taiwan
• ²²Department of Psychology, Northumbria University, Newcastle upon Tyne, North East England, United Kingdom
• ²³School of Allied Health and Social Care, Anglia Ruskin University, Cambridge, East of England, United Kingdom

The conjunction of physical frailty and cognitive impairment without dementia is described as Cognitive Frailty (CF). Indications that CF is potentially reversible have led to proposals that risk factors, symptoms or mechanisms of CF would be appropriate targets for interventions for prevention, delay or reversal. However, no study has brought experts together across sectors to determine targets, content or mode of interventions, and most resources on interventions are from the perspective of academic or clinical researchers only. This international Delphi consensus study brings together experts from academic and clinical research, lay people with lived experience of CF, informal carers, and professional care practitioners/clinicians. Methods: Three rounds of Delphi study were held to discern which factors and statements were agreed upon by the whole sample and which generated different views in those with differing expertise. A scoping review and Round 1 (29 participants) were used to gather initial statements. In Round 2, 58 people responded to statements and open text items, comprising 7 lab-based researchers, 27 researchers working with people, 14 people with lived experience or informal family carers, and 10 professional carers/clinicians. Percent agreement and qualitative responses were analysed to provide a final set of statements which were checked by 38 respondents in Round 3.Analysis of Round 2 quantitative data provided 74 statements on which there was at least 70% agreement and qualitative data produced a further 24 statements. These were combined to provide 90 statements for Round 3. There was Consensus for 89 of the statements. A few differences between the groups were observed at both stages.The consensus for statements associated with CF interventions provides a useful first step in defining health promotion activities and interventions. Given the prevalence and potential disability caused by CF in older populations, the consensus statements represent expert opinion that is inter-sectoral and will inform public health policies to support implementation of evidence-based prevention and intervention plans. This study is an important step towards changing current approaches, by including all stakeholders from the outset. Outcomes can be used to feed into co-creation of interventions for cognitive frailty.