A CONCEPTUAL MODEL OF FRAILTY IN OLDER ADULTS: A LITERATURE REVIEW This review employed several key procedures to synthesize the current evidence on frailty. An extensive literature search was conducted across major databases to identify relevant studies on frailty definitions, epidemiology, assessment tools, interventions, and conceptual models. The search results were analyzed using bibliometric techniques including thematic mapping with Biblioshiny and co-occurrence network visualization with VOSviewer. These bibliometric analyses identified core research themes, emerging topic clusters, and connections across the frailty literature. The main findings highlighted frailty's multidimensional nature spanning physical, cognitive, psychological, and social domains. While the frailty phenotype by Fried et al. (2) provided an initial operational definition, subsequent models increasingly encompassed a broader biopsychosocial frailty construct. Globally, over 10% of community-dwelling older adults were estimated as frail, with rates exceeding 40% in those over 90 years old. Frailty was associated with numerous adverse outcomes like disability, falls, hospitalization and mortality. Current assessment approaches included the frailty phenotype, frailty index, and various clinical performance tests, though no single comprehensive tool existed. Evidence supported tailoring multimodal interventions combining physical, nutritional, cognitive, psychological and social strategies to individual risk profiles. The principal conclusion was the critical need for a unified, holistic conceptual model elucidating the complex interplay of factors driving frailty's development and progression. Integrating the findings, a biopsychosocial framework was proposed conceptualizing frailty as a multifactorial health state arising from the cumulative impact of interconnected physical, cognitive, psychological, social and environmental determinants over the life course. Such models are essential for advancing frailty science, shaping clinical practices, and informing policies to promote healthy, resilient aging amid rapidly aging populations worldwide.

THE EFFECTIVENESS OF MULTI-COMPONENT EXERCISE COMBINED WITH ART THERAPY ON MUSCLE STRENGTH AND DEPRESSION AMONG COMMUNITY-DWELLING OLDER ADULTS: A PILOT STUDY Background: Physical and psychological declines often accompany aging, negatively impacting quality of life. Multimodal interventions may efficiently address multiple needs, but few studies have examined combined exercise and creative arts programs. Objective: This pilot study aimed to determine the feasibility and potential impacts of a multi-component exercise plus art therapy intervention for improving muscle strength and depression levels in community-dwelling older adults. Methods: Thirty-seven adults aged ≥ 55 years were randomized into exercise alone (EG = 12), art therapy alone (AG = 12), or combined exercise-art therapy (CG = 13). The 8-week interventions were performed at home. EG and CG engaged in moderate aerobic, resistance, balance, and flexibility exercises 3x/week. AG and CG also completed biweekly art therapy sessions involving coloring, weaving, stamping, and painting projects. Upper and lower limb muscle strength and depression levels were assessed at baseline and post-intervention. Results: All groups showed significant pre-to-post improvements in muscle strength and depression. However, there were no significant differences between-group, although CG tended to have the greatest gains. Conclusions: Home-based exercise and art therapy were feasible and improved outcomes. The combination group showed promising synergistic trends, supporting further research on multimodal interventions to promote successful aging through engaging programs that address both physical and mental health.

INTRODUCTION Although the benefits of physical activity and exercise are widely acknowledged, many middle-aged and elderly individuals remain sedentary. This cross-sectional study aimed to identify the external and internal barriers to physical activity and exercise participation among middle-aged and elderly individuals, as well as identify any differences in these barriers between the two groups. METHODS Recruited individuals were categorised into either the middle-aged (age 45-59 years, n = 60) or elderly (age ≥ 60 years, n = 60) group. Data on demographics, anthropometry, as well as external and internal barriers to participation in physical activity and exercise were collected. RESULTS Analysis showed no significant differences in the total scores of all internal barriers between the two groups (p > 0.05). The total scores for most external barriers between the two groups also showed no significant differences (p > 0.05); only 'cost' (p = 0.045) and 'exercise interferes with social/family activities' (p = 0.011) showed significant differences. The most common external barriers among the middle-aged and elderly respondents were 'not enough time' (46.7% vs. 48.4%), 'no one to exercise with' (40.0% vs. 28.3%) and 'lack of facilities' (33.4% vs. 35.0%). The most common internal barriers for middle-aged respondents were 'too tired' (48.3%), 'already active enough' (38.3%), 'do not know how to do it' (36.7%) and 'too lazy' (36.7%), while those for elderly respondents were 'too tired' (51.7%), 'lack of motivation' (38.4%) and 'already active enough' (38.4%). CONCLUSION Middle-aged and elderly respondents presented with similar external and internal barriers to physical activity and exercise participation. These factors should be taken into account when healthcare policies are being designed and when interventions such as the provision of facilities to promote physical activity and exercise among older people are being considered.
Age Factors ; Aged ; Cross-Sectional Studies ; Exercise ; physiology ; Female ; Follow-Up Studies ; Health Promotion ; utilization ; Health Status ; Humans ; Malaysia ; Male ; Middle Aged ; Motivation ; Motor Activity ; physiology ; Patient Participation ; utilization ; Retrospective Studies