Association of the FRAIL Scale with Rehabilitation Outcomes in the Community Hospital Setting

Overview

Journal Singapore Med J

Specialty General Medicine

Date 2021 Oct 4

PMID 34602720

Authors

Jeffrey Jiang

Audrey Yan Yi Han

Joel Goh

Affiliations

Soon will be listed here.

Abstract

Introduction: Frailty is associated with adverse health outcomes and can be measured using the FRAIL scale. In Singapore, its use has been studied in tertiary hospitals but not in community hospitals. A tool to predict rehabilitation outcomes would allow for better risk stratification and allocation of resources. We aimed to determine whether the FRAIL scale is associated with rehabilitation outcomes in patients admitted to the community hospital setting, where post-acute care and rehabilitation are primarily delivered.

Methods: This was a retrospective cohort study. The FRAIL scale was utilised to screen 560 older adults who were admitted to a community hospital for rehabilitation. Data were analysed to determine the relationship between baseline characteristics and frailty status, with rehabilitation outcome measures of absolute functional gain, rehabilitation effectiveness, rehabilitation efficiency, length of stay and discharge destination.

Results: The combined score of the FRAIL scale showed significant negative association with absolute functional gain (P < 0.001), rehabilitation effectiveness (P < 0.001) and rehabilitation efficiency (P < 0.001), whereas it was positively associated with increased length of stay (P < 0.05) and a need for continued support in increased care settings (P < 0.001). Individual components of the FRAIL scale, in particular, the 'fatigue', 'ambulation' and 'loss of weight' components, appeared to be highly associated with rehabilitation effectiveness and efficiency, especially among pre-frail patients.

Conclusion: The utility of the FRAIL scale as an indicator of frailty status and its association with rehabilitative outcomes in the post-acute care setting were demonstrated. Moreover, the FRAIL scale may better predict the rehabilitative progress of pre-frail patients.

Citing Articles

Models of community hospitals and state of research in high-income countries: a scoping review.

Tan M, Seah S, Seah X, Teo S, Leow J, Low L Front Public Health. 2025; 12:1507729.

PMID: 39917519 PMC: 11799244. DOI: 10.3389/fpubh.2024.1507729.

References

Koh G, Chen C, Petrella R, Thind A . Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open. 2013; 3(9):e003483. PMC: 3787469. DOI: 10.1136/bmjopen-2013-003483. View

Landi F, Bernabei R, Russo A, Zuccala G, Onder G, Carosella L . Predictors of rehabilitation outcomes in frail patients treated in a geriatric hospital. J Am Geriatr Soc. 2002; 50(4):679-84. DOI: 10.1046/j.1532-5415.2002.50162.x. View

Li Y, Zou Y, Wang S, Li J, Jing X, Yang M . A Pilot Study of the FRAIL Scale on Predicting Outcomes in Chinese Elderly People With Type 2 Diabetes. J Am Med Dir Assoc. 2015; 16(8):714.e7-714.e12. DOI: 10.1016/j.jamda.2015.05.019. View

Koh G, Wee L, Rizvi N, Chen C, Cheong A, Fong N . Socio-demographic and clinical profile of admissions to community hospitals in Singapore from 1996 to 2005: a descriptive study. Ann Acad Med Singap. 2012; 41(11):494-510. View

Mitnitski A, Mogilner A, Rockwood K . Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2003; 1:323-36. PMC: 6084020. DOI: 10.1100/tsw.2001.58. View

Morley J, Vellas B, Abellan van Kan G, Anker S, Bauer J, Bernabei R . Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14(6):392-7. PMC: 4084863. DOI: 10.1016/j.jamda.2013.03.022. View

Morley J, Malmstrom T, Miller D . A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012; 16(7):601-8. PMC: 4515112. DOI: 10.1007/s12603-012-0084-2. View

Shah S, Vanclay F, Cooper B . Efficiency, effectiveness, and duration of stroke rehabilitation. Stroke. 1990; 21(2):241-6. DOI: 10.1161/01.str.21.2.241. View

Heinemann A, Roth E, Cichowski K, BETTS H . Multivariate analysis of improvement and outcome following stroke rehabilitation. Arch Neurol. 1987; 44(11):1167-72. DOI: 10.1001/archneur.1987.00520230051013. View

10.

Dent E, Lien C, Lim W, Wong W, Wong C, Ng T . The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc. 2017; 18(7):564-575. DOI: 10.1016/j.jamda.2017.04.018. View

11.

Vaingankar J, Chong S, Abdin E, Picco L, Chua B, Shafie S . Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int. 2016; 17(10):1444-1454. DOI: 10.1111/ggi.12891. View

12.

Haley M, Wells Y, Holland A . Relationship between frailty and discharge outcomes in subacute care. Aust Health Rev. 2013; 38(1):25-9. DOI: 10.1071/AH13067. View

13.

Morley J . The New Geriatric Giants. Clin Geriatr Med. 2017; 33(3):xi-xii. DOI: 10.1016/j.cger.2017.05.001. View

14.

Chan C, Lee K, Low L . A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore. Int J Equity Health. 2018; 17(1):39. PMC: 5879561. DOI: 10.1186/s12939-018-0751-y. View

15.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan D, McDowell I . A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5):489-95. PMC: 1188185. DOI: 10.1503/cmaj.050051. View

16.

Tan L, Lim Z, Choe R, Seetharaman S, Merchant R . Screening for Frailty and Sarcopenia Among Older Persons in Medical Outpatient Clinics and its Associations With Healthcare Burden. J Am Med Dir Assoc. 2017; 18(7):583-587. DOI: 10.1016/j.jamda.2017.01.004. View

17.

Wang H, Fafard J, Ahern S, Vendittoli P, Hebert P . Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients. BMC Musculoskelet Disord. 2018; 19(1):14. PMC: 5771036. DOI: 10.1186/s12891-018-1935-8. View

18.

Kawryshanker S, Raymond W, Ingram K, Inderjeeth C . Effect of Frailty on Functional Gain, Resource Utilisation, and Discharge Destination: An Observational Prospective Study in a GEM Ward. Curr Gerontol Geriatr Res. 2014; 2014:357857. PMC: 3948590. DOI: 10.1155/2014/357857. View

19.

Woo J . Challenges of population ageing: putting frailty as a cornerstone of health and social care systems. Eur Geriatr Med. 2021; 9(3):273-276. DOI: 10.1007/s41999-018-0056-0. View

20.

Merchant R, Chen M, Tan L, Lim M, Ho H, van Dam R . Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults. J Am Med Dir Assoc. 2017; 18(8):734.e9-734.e14. DOI: 10.1016/j.jamda.2017.04.020. View