Individualized Hospital to Home, Exercise-Nutrition Self-Managed Intervention for Pre-Frail and Frail Hospitalized Older Adults: The INDEPENDENCE Randomized Controlled Pilot Trial
Chad Yixian Han, Yogesh Sharma, Alison Yaxley, Claire Baldwin, Richard Woodman, Michelle Miller
Abstract
Purpose: Pre-frailty and frailty in older adults are associated with poor health outcomes and increase health-care costs, and further worsening during hospitalization. This study aimed to examine the effect of an individualized hospital to home, exercise-nutrition self-managed intervention for pre-frail and frail hospitalized older adults. Patients and Methods: Older adults admitted to an acute medical unit of a tertiary hospital in South Australia who were pre-frail or frail were recruited from September 2020 to June 2021, randomized to either control or intervention group and followed up at 3 and 6 months. The outcome variables were program adherence, frailty status by the Edmonton Frail Scale (EFS) score, lower extremity physical function, handgrip strength, nutritional status, cognition, mood, health-related quality of life, risk of functional decline, unplanned readmissions. Results: Participants were 79.2 ± 6.6 years old, 63% female, mostly frail (67%), with EFS of 8.6± 1.9. Adherence to the inpatient and home visits/telehealth intervention were high (91± 13% and 92± 21%, respectively). Intention-to-treat analysis using linear regression models showed that participants in the intervention group had significantly greater reduction in EFS at 3 (− 3.0; 95% CI: − 4.8 to − 3.0) and 6 months (− 2.5; 95% CI: − 3.8 to − 1.0, P < 0.001 for both) compared to the control group; particularly the functional performance component. There were also improvements in overall Short Physical Performance Battery score at 3 (4.0; 95% CI: 1.3 to 6.6) and 6 months (3.9; 95% CI: 1.0 to 6.9, P < 0.05 for both), mini-mental state examination (2.6; 95% 0.3– 4.8, P =0.029) at 3 months and handgrip strength (3.7; 95% CI: 0.2– 7.1, P =0.039) and Geriatric Depression Scale, at 6 months (− 2.2; 95% CI: − 4.1 to − 0.30, P =0.026) in the intervention group as compared to control. Conclusion: This study provided evidence of acceptability to a patient self-managed exercise-nutrition program that may benefit and alleviate pre-frailty and frailty in hospitalised older adults. Keywords: frailty, self-management, exercise, nutrition therapy