Frailty affects the initial treatment response and time to recovery of mobility in acutely ill older adults admitted to hospital

Abstract

Objectives: to investigate how frailty and mobility impairment affect recovery of balance and mobility in acutely ill older patients. Design: secondary analysis of cohort study. Setting: general and geriatric medicine inpatient units, QEII Health Sciences Centre, Dalhousie University, Canada. Subjects: four hundred and nine older adults (mean age = 81 ± 7 standard deviation, 64% women). Methods: we constructed a frailty index based on a comprehensive geriatric assessment (FI-CGA), at baseline (2 weeks before admission; mean 0.31 ± 0.10), and on admission (mean 0.40 ± 0.10), and recorded Hierarchical Assessment of Balance and Mobility (HABAM) scores daily. Recovery was measured as the difference in HABAM scores between discharge and admission. Results: the odds of no or incomplete recovery increased by 1.06 (95% confidence interval: 1.01-1.11) for each 0.1 increment in the baseline FI-CGA. Recovery odds were similarly dependent on age, but independent of baseline HABAM scores. Recovery time was related to Day 1 HABAM scores, initial treatment response and change in the FI-CGA from baseline to admission (r = 0.35, P < 0.001). Recovery time was independent of age. Patients whose mobility improved within 48 h (n = 113; 28%) showed greater improvement and quicker recovery. Conclusions: frailer patients are at a greater risk of incomplete or lengthier recovery from impaired mobility and balance. Tracking mobility and balance might help providers, patients and families understand the course of acute illness in older adults.