Abstract
Objective
This study aimed to investigate if exercise therapy and polypharmacy was associated
with frailty state transitions for home care service recipients.
Design
Longitudinal cohort-study using client-level health information collected using interRAI
home care (RAI-HC) assessments.
Setting
Population-based study with Canadian home care clients in Alberta, British Columbia,
Ontario and the Yukon.
Participants
Home care clients aged 65 years and older.
Methods
A Markov chain multistate transition logistic regression model was used to calculate
ORs for state transitions with exercise therapy and polypharmacy as independent variables.
Results
In total, 250,428 home care clients experiencing 402,005 frailty state transitions
were included in the analyses. At baseline, 39.4% of clients were categorized as nonfrail,
30.2% were categorized as prefrail, and 30.4% were categorized as frail. Nonfrail
clients using polypharmacy were more likely to become prefrail (OR 1.16) and frail
(OR 1.11). Pre-frail clients using polypharmacy were more likely to become frail (OR
1.06), and they were less likely to become nonfrail (OR 0.80). Frail clients using
polypharmacy were significantly less likely to become prefrail (OR 0.82) or nonfrail
(OR 0.62). Nonfrail clients who participated in exercise therapy were more likely
to become prefrail (OR 1.05). Prefrail clients who participated in exercise therapy
were more likely to become nonfrail (OR 1.26). Frail clients who participated in exercise
therapy were more likely to become nonfrail (OR 1.27) and prefrail (OR 1.12).
Conclusions and Implications
This study suggests that frailty among home care clients can be reversed. Frailty
state improvement occurred significantly more often among home care clients receiving
exercise therapy and significantly less often among clients with polypharmacy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Understanding frailty.Postgrad Med J. 2007; 83: 16-20
- Frailty syndrome: An overview.Clin Interv Aging. 2014; 9: 433-441
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Frailty in elderly people.Lancet. 2013; 381: 752-762
- Operationalizing a frailty index from a standardized comprehensive geriatric assessment.J Am Geriatr Soc. 2004; 52: 1929-1933
- A standard procedure for creating a frailty index.BMC Geriatr. 2008; 8: 24
- Implementing frailty measures in the Canadian Healthcare System.J Frailty Aging. 2018; 7: 208-216
- Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis.BMJ Open. 2018; 8: e018195
- Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis.Arch Phys Med Rehabil. 2012; 93: 237-244
- Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis.Ageing Res Rev. 2012; 11: 136-149
- Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: A systematic review and meta-analysis.Arch Phys Med Rehabil. 2014; 95: 753-769.e3
- The effectiveness of exercise interventions for the management of frailty: A systematic review.J Aging Res. 2011; 2011 (569194)
- Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults.J Am Med Dir Assoc. 2012; 13: 507-511
- Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: A randomized controlled trial.J Am Med Dir Assoc. 2012; 13: 24-30
- The relationship between frailty and polypharmacy in older people: A systematic review.Br J Clin Pharmacol. 2018; 84: 1432-1444
- Frailty consensus: A call to action.J Am Med Dir Assoc. 2013; 14: 392-397
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457
- Outcome measures for use with home care clients.Can J Aging Rev Can Vieil. 2000; 19: 87-105
- Sharing clinical information across care settings: The birth of an integrated assessment system.BMC Health Serv Res. 2009; 9: 71
- Second and third generation assessment instruments: The birth of standardization in geriatric care.J Gerontol A Biol Sci Med Sci. 2008; 63: 308-313
- Comprehensive clinical assessment in community setting: Applicability of the MDS-HC.J Am Geriatr Soc. 1997; 45: 1017-1024
- Evaluation of data quality of interRAI assessments in home and community care.BMC Med Inform Decis Mak. 2017; 17: 150
- Reliability of the interRAI suite of assessment instruments: A 12-country study of an integrated health information system.BMC Health Serv Res. 2008; 8: 277
- Impact of a new assessment system, the MDS-HC, on function and hospitalization of homebound older people: A controlled clinical trial.J Am Geriatr Soc. 2001; 49: 1288-1293
- Minimum data set for home care: A valid instrument to assess frail older people living in the community.Med Care. 2000; 38: 1184-1190
- Updating the Cognitive Performance Scale.J Geriatr Psychiatry Neurol. 2016; 29: 47-55
- Adverse Events in Home Care: Identifying and Responding with interRAI Scales and Clinical Assessment Protocols.Can J Aging Rev Can Vieil. 2018; 37: 60-69
- Use of the interRAI CHESS Scale to predict mortality among persons with neurological conditions in three care settings.PLOS ONE. 2014; 9: e99066
- Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients.Age Ageing. 2010; 39: 755-758
- Using an accumulation of deficits approach to measure frailty in a population of home care users with intellectual and developmental disabilities: An analytical descriptive study.BMC Geriatr. 2015; 15: 170
- Derivation of a frailty index from the interRAI acute care instrument.BMC Geriatr. 2015; 15: 27
- Identification of older adults with frailty in the emergency department using a frailty index: Results from a multinational study.Age Ageing. 2018; 47: 242-248
- Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living.BMC Geriatr. 2012; 12: 56
- What is polypharmacy? A systematic review of definitions.BMC Geriatr. 2017; 17: 230
- Rehabilitation in home care is associated with functional improvement and preferred discharge.Arch Phys Med Rehabil. 2013; 94: 1038-1047
- Multistate models for the analysis of life history data.CRC Press, Boca Raton, FL2018
- Predicting future health transitions among newly admitted nursing home residents with heart failure.J Am Med Dir Assoc. 2019; 20: 438-443
- Association between polypharmacy and death: A systematic review and meta-analysis.J Am Pharm Assoc. 2017; 57: 729-738.e10
- Prevention of potentially inappropriate prescribing for elderly patients: A randomized controlled trial using STOPP/START criteria.Clin Pharmacol Ther. 2011; 89: 845-854
- Reduction of potentially inappropriate medications using the STOPP criteria in frail older inpatients: A randomised controlled study.Drugs Aging. 2014; 31: 291-298
- Education to reduce potentially harmful medication use among residents of assisted living facilities: A randomized controlled trial.J Am Med Dir Assoc. 2014; 15: 892-898
- The feasibility and effect of deprescribing in older adults on mortality and health: A systematic review and meta-analysis.Br J Clin Pharmacol. 2016; 82: 583-623
- Physical activity and older adults: A review of health benefits and the effectiveness of interventions.J Sports Sci. 2004; 22: 703-725
- Effects of physical exercise interventions in frail older adults: A systematic review of randomized controlled trials.BMC Geriatr. 2015; 15: 154
- Is it time to ban the P value?.JAMA Psychiatry. 2019; 76: 1219-1220
- Statistical tests, P values, confidence intervals, and power: A guide to misinterpretations.Eur J Epidemiol. 2016; 31: 337-350
- The ASA statement on P values: Context, process, and purpose.Am Stat. 2016; 70: 129-133
- Do not over (P) value your research article.JAMA Cardiol. 2016; 1: 1055
Article info
Publication history
Published online: March 10, 2020
Footnotes
This article was produced as part of project REACH. This project received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 690425. (REACH | HORIZON 2020. http://reach2020.eu/?page_id=1485. Accessed November 23, 2017).
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
