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Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. NU Hospital Grp, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens University Hospital, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU Hospital Grp, Sweden.
2017 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, p. 1929-1939Article in journal (Refereed) Published
Abstract [en]

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 pamp;lt;0.001, 6-MWT pamp;lt;0.001, TUG pamp;lt;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.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD , 2017. Vol. 12, p. 1929-1939
Keywords [en]
frail elderly; comprehensive geriatric assessment; physical fitness; outcomes
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-143250DOI: 10.2147/CIA.S149665ISI: 000415128600002OAI: oai:DiVA.org:liu-143250DiVA, id: diva2:1160425
Note

Funding Agencies|NU Hospital Group, Department of Research and Development

Available from: 2017-11-27 Created: 2017-11-27 Last updated: 2020-04-07
In thesis
1. Physical Fitness in Hospitalized Frail Elderly Patients
Open this publication in new window or tab >>Physical Fitness in Hospitalized Frail Elderly Patients
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Demographic research shows that the proportion of older people in society is increasing. More people age well, but there are also more people getting old with disability and multimorbidity. The large diversity in functioning illustrates the heterogeneity of aging. Accelerated aging may lead to frailty, which is a geriatric syndrome, often used as a marker of biologic age and associated with decreased physiologic reserves, increased vulnerability and the risk of adverse health out- comes. Frail elderly people are frequent visitors within emergency hospital care and physical decline is common. Unfortunately, elderly patients with substantial multimorbidity are often excluded from clinical trials.

Physical fitness comprises a set of measurable health- and skill-related outcomes, such as cardiorespiratory endurance and muscle strength. A decrease in physical fitness may affect the prognosis negatively. However, previous research indicates that it may be possible to reverse frailty and improve physical fitness. It is therefore of the utmost interest to identify frailty and study how care is best provided, in order to prevent, reduce and postpone adverse health consequences.

The overall aim of this thesis is to study physical fitness in a group of frail elderly patients, within clinical hospital health care. The patients’ physical fitness will be evaluated and compared in different care settings during and after hospitalization. The aim is also to study the long-term consequences of changes in physical fitness in relation to mortality. To better understand the underlying factors for partici- pation in physical activity and exercise, patients’ perceptions of the phenomena will be explored.

This thesis consists of four papers based on two studies comprising frail elderly patients with substantial multimorbidity, in connection with an in-hospital episode.

Paper 1 was an observational study with a cross-sectional design (n=408). Different components of physical fitness were measured during an index hospital stay and the results showed that hospitalized frail elderly patients performed below previously described age-related reference values. Furthermore, physical fitness was associated with the degree of frailty, rather than the chronological age.

Paper 2 was a prospective controlled trial, with two parallel groups. The patients included in the intervention group (n=206) were cared for at an emergency medical care unit providing care according to Comprehensive Geriatric Assessment and care (CGA). The control group (n=202) was cared for at conventional emergency medical care units. The multi-professional care approach at the CGA unit was shown to be beneficial, in terms of a greater proportion of patients who preserved or improved their function during the first three months after discharge from hospital, compared with conventional care.

Paper 3 had a prospective approach when evaluating the association between physical fitness and oneyear mortality in those 390 patients discharged alive from a hospital care episode. The results showed that physical fitness during in-hospital care and the change in physical fitness during the first months after discharge were associated with one-year mortality.

In Paper 4, the patients’ perspective in terms of physical activity and exercise was explored. The theme of “Meaningfulness and risk of harm in an aging body” emerged, followed by the three categories of physical activity as part of daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise.

These studies highlight the importance of a greater focus on physical fitness in hospitalized elderly patients. A careful assessment and a multi-professional approach may lead to beneficial results and better survival even in a group of frail elderly patients with severe multimorbidity. To increase physical activity and exercise in this group of patients, health care probably needs to improve the means of communicating the benefits and goals of exercise and facilitating them so that the risk of harm is reduced.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2020. p. 90
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1733
Keywords
Physical fitness, frailty, in-hospital care, comprehensive geriatric assessment
National Category
Nursing Geriatrics
Identifiers
urn:nbn:se:liu:diva-164961 (URN)10.3384/diss.diva-164961 (DOI)9789179298906 (ISBN)
Public defence
2020-05-14, Berzeliussalen, Building 463, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-04-07 Created: 2020-04-07 Last updated: 2020-04-07Bibliographically approved

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Åhlund, KristinaBäck, MariaÖberg, BirgittaEkerstad, Niklas
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