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.