Clinical Interventions in Aging (May 2023)
Individualized Hospital to Home, Exercise-Nutrition Self-Managed Intervention for Pre-Frail and Frail Hospitalized Older Adults: The INDEPENDENCE Randomized Controlled Pilot Trial
Abstract
Chad Yixian Han,1 Yogesh Sharma,2,3 Alison Yaxley,1 Claire Baldwin,1 Richard Woodman,2 Michelle Miller1 1Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; 2College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; 3Department of General Medicine, Flinders Medical Centre, Adelaide, SA, AustraliaCorrespondence: Chad Yixian Han, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA5042; GPO Box 2100, Adelaide, SA, 5001, Australia, Tel +61 8201 3911, Email [email protected]: 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
