Poster Presentation 6th Annual Scientific Meeting of the Australian and New Zealand Society for Sarcopenia and Frailty Research 2024

Enhancing community support for frail older adults after an acute hospitalisation: Insights from the FORTRESS Plus study (#3)

Rosanna Tran 1 2 , Sue Kurrle 1 2 , Ian Cameron 2 3 , Keri Anne Lockwood 1 2 , Annette Kifley 3
  1. Faculty of Medicine and Health , The University of Sydney , Sydney, NSW, Australia
  2. Rehabilitation and Aged Care, Northern Sydney Local Health District , Sydney, NSW, Australia
  3. John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia

Background
There is a lack of a standardised pathway for frailty identification and intervention in acute hospital settings and in the community.1 Frailty can precipitate falls in the home setting if left untreated and can lead to adverse outcomes such as hospitalisation, longer hospital admission, and increased risk of readmission. Frail older adults frequently present with poor baseline physical function, evident in reduced ambulation and muscle strength.2 Many frail older adults are discharged without an exercise plan or formal ADL (activities of daily living) assessment. Such oversights contribute to functional decline post-discharge, elevating the risk of readmission and eventual institutionalization within a year.

Key Findings

The previously conducted FORTRESS2 and FIT3 studies highlight the necessity of comprehensive community support for frail individuals post-discharge. Initial insights suggest that:

  • General practitioners often do not engage with frailty management plans initiated during hospitalization.
  • A few home visits from a community nurse and phone follow-ups are insufficient to drive positive outcomes.
  • Delays in connecting to community services worsen deconditioning, increasing the risk of rehospitalisation.

The FORTRESS Plus intervention

Building on the FORTRESS study, the FORTRESS Plus study targets the same participant cohort but introduces enhanced community support. This includes up to 7 weekly supervised progressive exercise sessions at home post-discharge, delivered by an Exercise Physiologist, aligning more closely with the successful FIT Study intervention.

The FIT study findings underscore the benefits of enhanced social engagement through multiple home visits by clinicians. Key insights reveal:

  • Older adults are more inclined to adhere to physical activity programs if supervised, tailored, and supported by self-efficacy training.
  • Early intervention within the first month of discharge, led by an exercise physiologist or physiotherapist, ensures safe, effective exercise progression, and addresses dietary and medication concerns.
  • Continuous clinician follow-up is crucial to guide exercise intensity progression and avoid functional gains plateauing.

Conclusion

A multifaced, multidisciplinary approach is needed to reduce the risk of readmission among frail older adults post hospitalisation.3 The FORTRESS Plus study looks to provide comprehensive support through intensive home-based supervised exercise sessions and the active engagement of caregivers to foster adherence. Current clinical practice guidelines should be revised to better cater to the rehabilitation needs of frail older adults, ensuring improved outcomes and enhanced quality of life.1

  1. 1. Dent, E., Hanlon, P., Sim, M., Jylhävä, J., Liu, Z., Vetrano, D. L., … Hoogendijk, E. O. (2023). Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in Geriatrics and gerontology. Ageing Research Reviews, 91, 102082. doi:10.1016/j.arr.2023.102082
  2. 2. Block, H., Annesley, A., Lockwood, K., Xu, L., Cameron, I. D., Laver, K., … Kurrle, S. E. (2022). Frailty in older people: Rehabilitation treatment research examining separate settings (FORTRESS): Protocol for a hybrid type II stepped wedge, cluster, randomised trial. BMC Geriatrics, 22(1). doi:10.1186/s12877-022-03178-1
  3. 3. Cameron, I. D., Fairhall, N., Langron, C., Lockwood, K., Monaghan, N., Aggar, C., … Kurrle, S. E. (2013). A multifactorial interdisciplinary intervention reduces frailty in older people: Randomized trial. BMC Medicine, 11(1). doi:10.1186/1741-7015-11-65