Frailty Measures and their Association with Post-Acute Rehabilitation Outcomes

Introduction: With frailty a worldwide concern in a rapidly expanding ageing population, proactive approaches to the management and identification of frailty are recommended to help reduce hospitalisations and adverse outcomes. Yet, there is lack of evidence for frailty screening and rehabilitation of adults in an Irish post-acute rehabilitation setting.

Aims and Objective: The primary aim of this study was to compare clinicians’ appraisal and patients’ subjective appraisal of frailty and explore their association with each other and with post-acute rehabilitation outcomes.

Methods: In a prospective cohort observational study in Peamount Healthcare from Oct. 2019-Feb. 2020 32 participants were assessed on admission and discharge. Frailty was measured through clinicians’ appraisal using the Clinical Frailty Scale (CFS) and patients’ subjective appraisal using the Identification of Seniors at Risk Questionnaire (ISAR). Rehabilitation outcomes were measured using the Timed Up and Go (TUG), the Elderly Mobility Scale (EMS) and the Euro-Qol 5D (EQ-5D).

Results: Mean age of participants was 82.66 (±SD 8.31) years. There was no significant difference in the level of frailty reported by clinicians and patients (81.3% vs 84.4%) and no association was found between the ISAR and CFS. Significant improvements were noted in the TUG (p<0.001) the EMS (p<0.001), left grip strength (p=0.05), EQ5D Visual Analogue Scale (p=0.002) and in EQ5D domains except anxiety/depression. A relationship was observed between clinicians’ rating of frailty on admission with measures of activity limitations on discharge with a strong positive association found with TUG (p<0.001) on discharge and a strong negative association with the EMS (p<0.001) on discharge. Little association was noted between levels of impairment and participation restriction. Moderate to strong relationships were found between patients’ frailty appraisals on admission with measures of quality of life on discharge with no associations noted with levels of impairment and activity limitation.

Conclusion: The association of levels of frailty with rehabilitation outcomes varied by method of frailty appraisal used. Both methods provide different yet potentially complementary information in relation to rehabilitation outcomes.

Implications of Findings: This research found improvements in frail older adults following post-acute rehabilitation, however there was variability in levels of frailty in this setting depending on the frailty screening measure used.