Effects of a modified Hospital Elder Life Program on frailty in individuals undergoing major elective abdominal surgery

Abstract

Objectives: To test the effects of a modified Hospital Elder Life Program (mHELP) on frailty.

Design: Matched and unmatched analyses of data from a before-and-after study.

Setting: Hospital, inpatient.

Participants: Participants aged 65 and older (n = 189) undergoing major elective abdominal surgery at a medical center in Taiwan.

Intervention: The mHELP included three nursing interventions: early mobilization, oral and nutritional assistance, and orienting communication.

Measurements: Frailty rate and transitions between frailty states from hospital discharge to 3 months after discharge using Fried's phenotype criteria categorized as nonfrail (0 or 1 criteria present), prefrail (2 or 3 criteria present), and frail (4 or 5 criteria present).

Results: In matched pairs, participants who received the mHELP interventions were significantly less likely to be frail at discharge (19.2%) than matched controls (65.4%) (adjusted odds ratio (AOR) = 0.10, 95% CI = 0.02-0.39). Transitions to states of greater frailty during hospitalization were more common for participants in the control group. Three months after discharge, participants who received the mHELP intervention during hospitalization were less likely to be frail (17.3%) than matched controls (23.1%) (AOR = 0.73, 95% CI = 0.21-2.56), although this difference did not achieve statistical significance.

Conclusion: The mHELP intervention is effective in reducing frailty by hospital discharge, but the benefit is diminished by 3 months after discharge. Thus, the mHELP provides a useful approach to manage in-hospital frailty for older adults undergoing major abdominal surgery.

Keywords: aged; frailty; geriatric syndromes; intervention studies; surgery.

Figure 1. The Study Flowchart

Figure 2a. Transitions between frailty States (from admission to discharge) for 52 matched pairs

Notes. The x-axis represents the frailty states at admission (baseline) for both groups, and the y-axis shows the rates of transitions to each frailty state by hospital discharge

Figure 2b. Transitions between frailty States (from Admission to 3 months after Discharge) for 52 matched pairs

Notes. The x-axis represents the frailty states at admission (baseline) for both groups, and the y-axis shows the rates of transitions to each frailty state by 3-month follow-up