Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients
Received 22 August 2017
Accepted for publication 3 October 2017
Published 13 November 2017 Volume 2017:12 Pages 1929—1939
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Dr Richard Walker
Kristina Åhlund,1,2 Maria Bäck,2,3 Birgitta Öberg,2 Niklas Ekerstad4,5
1Department of Physiotherapy, NU Hospital Group, Trollhättan, 2Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, 3Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, 4Department of Cardiology, NU Hospital Group, Trollhättan, 5Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
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: frail elderly, comprehensive geriatric assessment, physical fitness, outcomes
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