Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients

Abstract

Introduction: Frail elderly people often use emergency care. During hospitalization, physical decline is common, implying an increased risk of adverse health outcomes. Comprehensive Geriatric Assessment (CGA) has been shown to be beneficial for these patients in hospital care. However, there is very limited evidence about the effects on physical fitness. The aim was to compare effects on physical fitness in the acute care of frail elderly patients at a CGA unit versus conventional care, 3 months after discharge.

Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted. Patients aged ≥75 years, assessed as frail and in need of inpatient care, were assigned to a CGA unit or conventional care. Measurements of physical fitness, including handgrip strength (HS), timed up-and-go (TUG), and the 6-minute walk test (6-MWT) were made twice, at the hospital index care period and at the 3-month follow-up. Data were analyzed as the mean change from index to the 3-month follow-up, and dichotomized as decline versus stability/improvement in physical fitness.

Results: In all, 408 participants, aged 85.7±5.4 years, were included. The intervention group improved significantly in all components of physical fitness. The controls improved in TUG and declined in HS and 6-MWT. When the changes were dichotomized the intervention group declined to a lesser extent; HS p<0.001, 6-MWT p<0.001, TUG p<0.003. The regression analysis showed the following odds ratios (ORs) for how these outcomes were influenced by the intervention; HS OR 4.4 (confidence interval [CI] 95% 2.2-9.1), 6-MWT OR 13.9 (CI 95% 4.2-46.2), and TUG OR 2.5 (CI 95% 1.1-5.4).

Conclusion: This study indicates that the acute care of frail elderly patients at a CGA unit is superior to conventional care in terms of preserving physical fitness at 3 months follow-up. CGA management may positively influence outcomes of great importance for these patients, such as mobility, strength, and endurance.

Keywords: comprehensive geriatric assessment; frail elderly; outcomes; physical fitness.

Figure 1

Flowchart of data collection – physical fitness. Notes: Flowchart completed here with information regarding participants’ performance of physical fitness instruments. Copyright © 2017. Dove Medical Press. Adapted from Ekerstad N, Karlson BW, Dahlin Ivanoff S, et al. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care? Clin Interv Aging. 2017;12:1–9. Abbreviations: HS, handgrip strength; TUG, timed up-and-go; 6-MWT, 6-minute walk test.

Figure 2

Changes in physical fitness in CGA unit and conventional care. Notes: The number (%) of patients that declined, were stable, or improved in physical fitness in CGA unit (intervention group) and in conventional care (control group). We used the change of the study population, and if changed one quartile or more, it was assumed to be a relevant change. Handgrip strength (kg): decline: <−2 kg, stable: −1 to +2 kg, improvement: ≥+3 kg. 6-MWT (m): decline: <−50 m, stable: −49 to +23 m, improvement: >+24 m. TUG (s): decline: slower than +1.3 s, stable: +1.2 to −6.3 s, improvement: faster than −6.4 s. Abbreviations: TUG, timed up-and-go; 6-MWT, 6-minute walk test; CGA, Comprehensive Geriatric Assessment.