Upper-Extremity Function Predicts Adverse Health Outcomes among Older Adults Hospitalized for Ground-Level Falls

Abstract

Background: Despite National Surgical Quality Improvement guidelines to integrate frailty into surgical elder assessments, a quick, accurate, and simple frailty assessment tool suitable for busy clinical settings is still not available. Recently, we have demonstrated that a simple upper-extremity function (UEF) test based on wearable sensors could identify frailty with high agreement with conventional assessments by testing 20-s repetitive elbow flexion and extension. Objective: We examined whether UEF parameters are sensitive for predicting adverse health outcomes in bedbound older adults admitted to hospital due to ground-level fall injuries. Study Design: Frailty was assessed in 101 eligible older adults (age: 79 ± 9 years) admitted to a trauma setting using the UEF test at the time of admission. All participants were followed up for 2 months using phone calls and chart reviews. The measured health outcomes included (1) discharge disposition (favorable: discharge home or rehabilitation; unfavorable: discharge to skilled nursing facility or death), (2) hospital length of stay, (3) 30-day readmission, (4) 60-day readmission, and (5) 30-day prospective falls. Multivariate analyses were used to identify independent predictors of adverse health outcomes based on participants' demographic parameters (i.e., age, gender, and body mass index [BMI]) and UEF index. Results: Based on the UEF frailty status, 53 (52%) of the participants were frail and 48 (48%) were non-frail. Among all adverse health outcomes, age was only a significant predictor of 30-day prospective falls (p = 0.023). On the other hand, the UEF index was a significant predictor of all measured outcomes except hospital length of stay (p < 0.010). Among the UEF parameters, those indicating slowness, weakness, and exhaustion had the highest effect sizes to predict an unfavorable discharge disposition (p < 0.010; effect size = 0.65-0.92). Conclusion: The results of this study suggest that a 20-s UEF test is practical in the trauma setting and could be used as a quick measure for predicting adverse events and outcomes among bedbound patients after discharge. Assessing frailty using UEF may assist in objective triage, treatment, and post-discharge decision-making with regard to geriatric trauma patients.

Upper-extremity function prospectively predicts adverse discharge and all-cause COPD readmissions: a pilot study

“…Similarly, in our population CCI was not a predictor of 30-day readmissions. These results, together with previous documented evidence regarding the importance of frailty in predicting adverse health outcomes,27,39–41 underlined the necessity of frailty assessments in hospitalized patients at the time of index admission.…”

“…Baseline clinical measures, including the COPD Assessment Test (CAT; score range from 0 to 40: best to worst score) and Charlson Comorbidity Index (CCI; score range from 0 to 39, representing the number of chronic conditions), were obtained from all participants. Based on chart reviews and telephone surveys, we determined the following health outcomes: discharge disposition (favorable: home; or unfavorable: home with care, rehabilitation center, skilled nursing facility, or death; see Joseph et al27,28 for more information regarding this classification), 30-day exacerbation requiring treatment, and 30-day readmission.…”

Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes

“…However, a continuous scale to describe frailty stages similar to the Rockwood Frailty index has not been developed because of the selection of the FFC as our gold standard. Another study is required to develop a continuous frailty model similar to a validated frailty meter with a continuous scale [25, 40]. We anticipate that a continuous frailty index may be more sensitive to change than a categorical frailty model, as suggested in previous studies [25, 40].…”

Wearable Sensors and the Assessment of Frailty among Vulnerable Older Adults: An Observational Cohort Study

“…To overcome limitations of the Fried frailty phenotype, researchers have proposed wearable sensors as an alternative to assessing the frailty phenotype [ 15 , 23 , 24 , 25 ]. These wearable sensors can address the challenges in measuring frailty, such as feasibility, practicality, ease of use, accessibility, reproducibility, and reliability, without hindering daily activity in the outpatient or inpatient settings [ 15 , 23 , 24 ]. Previous studies using a wrist sensor, by Lee et al, have demonstrated that a 20-s upper extremity test is capable of predicting frailty in the outpatient setting [ 26 ] and in community dwelling settings [ 27 ].…”