Frailty And Its Association With Rehabilitation Outcomes: An Irish Prospective Cohort Study Of A Post-Acute Older Population

Abstract

The projected increase in the older population over the coming decades will place a greater demand on health-care services. Frailty is highly prevalent in the hospitalised older adult. There is a lack of research examining the impact of frailty on determinants of physical function, quality-of-life and falls self-efficacy. Aims and Objectives: The primary aim of this research was to evaluate the changes in physical function, quality-oflife and falls self-efficacy in frail older adults undergoing inpatient rehabilitation. A secondary aim was to examine the association between frailty and rehabilitation outcomes of physical function, quality-of-life, self-efficacy, time spent in therapy, length of stay and discharge destination. Methods: A prospective cohort study design was employed using a sample of convenience. Forty-one subjects attending an inpatient post-acute rehabilitation unit were assessed on admission and at discharge. A range of physical determinants were used to assess function. They included the Clinical Frailty Scale (CFS), Grip-strength, Timed-Up-and-Go (TUG), ten meter walk test (10MWT), Elderly Mobility Scale (EMS), Tinetti Balance and Gait Assessment, Barthel ii Index (BI). The EuroQol-5D Visual Analogue Scale (EQ-5D-VAS) was used to assess quality-of-life and the Falls Efficacy Scale (FES) as a measure of falls self-efficacy. Results: The mean (±SD) age of the sample was 80.3(±7.1) years and the majority were female. Statistically significant changes from admission to discharge were found in the CFS (p≤0.001), grip-strength (p≤0.001), TUG (p≤0.001), 10MWT (p≤0.001), Tinetti (p≤0.001), BI (p≤0.001), EQ-5D-VAS (p≤0.001) and FES (p≤0.001). Moderate positive correlations were found between admission CFS and TUG (r=0.438, p Conclusions: Frailty on admission was shown to have a modest relationship with many physical determinants of function, time spent in therapy and length of stay. It is evident that frailty iii alone does not provide the clinician with a definitive clinical evaluation of an older person's potential outcome following rehabilitation. Implication of Findings: This research provides the clinician with a better understanding of the relationship between frailty and specific functional outcomes of the older person. Policy makers are also more informed of the influence of frailty on health-service provision in the older adult undergoing post-acute rehabilitation.