The aim of this study is to explore if the use of Sit to Stand Test and Gait speed Test could assist physiotherapist with discharge planning decisions for older adults who are admitted to an acute hospital.
Older adults are susceptible to acute illnesses which could predispose them to hospital admissions, with some of the common reasons for admission being infections, exacerbations of chronic conditions, and falls. This higher likelihood of older adults admitted to hospitals can be seen from the statistics from Ministry of Health in 2021 whereby older adults aged 65 years and older constitute up to 287.3 admissions per 1000 resident population, which is the highest among all age groups. In a study exploring the trend of injuries sustained by older adults presented to the Emergency Department of an acute hospital, 85.3% of all injuries sustained by older adults were due to falls. Common physical injuries sustained by older adults after a fall are fractures, bruises, and soft tissue injuries. Functional decline after a fall was also relatively common in older adults. Additionally, it has also been well recognized that hospitalisation may cause older adults to experience deconditioning. Therefore, older adults who are admitted to an acute hospital, especially those who are admitted due to falls or have a history of falls, are generally at high risk of having a change in their functional status. For the older adults with a change in functional status and have been assisted by a caregiver prior to their hospital admission, one of the main aims usually would be to make sure that their caregivers are still competent in caring for them after discharge. However, for older adults whose premorbid physical functional status are relatively independent, it is pertinent to establish if they are still safe to manage their own care after discharge from hospital. Proper discharge planning for this group of older adults is important to make sure that those who are discharge home will not experience functional decline or at increased risk of falls. Older adults who are admitted in an acute hospital are commonly referred to physiotherapists for assessment to determine are ready to return home or if they need further rehabilitation. However, to manage high workload in the acute hospital and space constraints in the wards, these older adults' readiness for home are frequently based on physiotherapists' clinical judgement, which may differ based on their clinical experience. Discharge planning is predominantly based on the comparisons between the older adults' self-reported functional mobility before hospital admission and the level of assistance they require during assessment by inpatient physiotherapists. Without the use objective outcome measures, there may be disagreement by medical team or family members on physiotherapist's recommendations. Furthermore, there is no venue to track the older adult's improvement objectively. STS and GST are two functional outcome measures that are validated to measure different physical aspects of older adults. STS has been shown to be able to assess lower limb strength, balance control and falls risk. This can be seen from the recommended use of STS in the acute setting for the assessment of lower limb strength and physical performance by a Singapore multidisciplinary consensus recommendation on muscle health in older adults by Chew et al. (2021). As for GST, it is reflective of a person's functional mobility whereby a study by Ostir et al., (2015) has demonstrated that GST can be used as a simple and quick screening tool for hospitalised older adults who may require further intervention with their mobility. As these two measures are easy to administer, less time-consuming and do not require much space, they may be suitable outcome measures to facilitate discharge planning. However, there is no literature demonstrating that they have been used to facilitate discharge planning for older adults in acute hospitals. Therefore, the primary aim of this study is to explore if the two outcome measures are useful in facilitating discharge planning for older adults who are admitted to an acute hospital. Our secondary aim is to determine if the discharge recommendations for participants to discharge home are accurate by looking for any change in the basic activity of living (ADL), self-reported fear of falls and activity confidence post-discharge
Study Type
OBSERVATIONAL
Enrollment
60
National University Hospital, Singapore
Singapore, Singapore
RECRUITINGFive Times Sit To Stand Test (STS)
STS will be used to test the lower limb strength, balance control and falls risk. Participants will have to stand up and sit down five times started from a seated position, with arms across their chest. The test will have to be conducted as fast as possible using a chair with a backrest. The time taken to complete 5 repetitions will be recorded. Two trials will be performed. A cut-off score of ≥ 12s will be considered at risk of falling.
Time frame: During Enrollment while admitted in acute hospital
Gait Speed Test
A 4m walk test will be used to measure gait speed. Participant will walk through a 4-metre distance at comfortable speed. The time taken to complete the distance will be recorded. Two trials will be performed. Gait speed of ≤ 0.6m/s would be termed as dismobility according to Cummings et al., (2014) which would be reflected of having poor mobility and will require intervention.
Time frame: During Enrollment while admitted in acute hospital
Calf Circumference
Calf circumference is a surrogate marker of muscle mass for older adults. It can be measured in sitting with the knee and ankle bent at a right angle and the feet flat on the floor. Using a measuring tape, the widest part of the part can be measured by applying the tape flat on the skin and parallel to the floor. Two measurements will be performed. A cut- off score of \< 34cm in men and \< 33cm in women will be consider as having low muscle mass and a higher risk of sarcopenia.
Time frame: During Enrollment while admitted in acute hospital
Hand grip strength
Hand grip strength measured by a hand dynamometer will be used to gauge frailty. Participant will sit in a chair with back support and asked to hold on to the dynamometer using maximum strength with the shoulder adducted and neutrally rotated, elbow flexed at 90 degrees, forearm neutral. The tested arm is not supported by examiner or armrest and the dynamometer is presented vertically and in line with the forearm. Three measurements will be performed. A cut off score of \< 28kg in male and \< 18kg in female is considered as having low handgrip strength.
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Time frame: During Enrollment while admitted in acute hospital
Lower limb muscle strength using hand-held dynamometer
Reduction in quadriceps muscles strength were the most affected with aging. Muscle strength of lower limb will be assessed with knee extension strength using an electronic push/pull dynamometer. Participants would be seated with knee flexed to 90 degrees. Isometric knee strength will be measured with an electronic dynamometer attached to lower leg. A cut off score of \< 23.64kg in male and \< 15.24kg in female is considered as having low knee extension strength.
Time frame: During Enrollment while admitted in acute hospital
Modified Barthel Index (MBI)
The modified barthel index (MBI) consist of 10 items of ADLS modified from Barthel index (Shah et al, 1989). This includes transfers, walking, navigating stairs, grooming, bathing, dressing, feeding, toilet transfer, bladder and bowel control. It has been validated for older adults living at home and hospitalised older adults. MBI is also commonly used to assess physical function for hospitalised older adults at admission and discharge. MBI is positively associated with functional performance even for older adults who are hospitalised. In addition, older adults with higher MBI scores and ADL independence were more likely to be discharged home post hospitalisation as well. MBI score of 0 to 24 points suggest total ADL dependency, score of 25 to 49 points suggest severe ADL dependency, score of 50 to 74 suggest moderate ADL dependency and scores above 75 suggest mild ADL dependency.
Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
Short Falls Efficacy Scale International (Short FES-I)
The Short FES-I measures the individual's concerns about falling. Seven questions were answered with a four-grade scale (1-4) of 'not at all concerned,' 'somewhat concerned,' 'fairly concerned' and 'very concerned.' The total score, which ranged from 7 to 28, was recorded. A higher score reflected a greater level of concern about falling. The Short FES-I have excellent psychometric properties and requires less time to conduct compared to the FES-I.
Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
Balance Recovery Confidence scale (BRC)
The BRC aims to measure the balance recovery confidence in community-dwelling older adults. A list of fall-related situations commonly experienced by older adults are presented to determine how certain the respondent can recover their balance to prevent a fall if the situation was to occur in the last three weeks by recording a number from 0 to 10 with 10 indicating "Highly certain can do" and 0 refers to "Cannot do at all".
Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
Mulitdimensional Falls Efficacy Scale (MdFES)
The MdFES was developed in collaboration between NUH and SIT (ITO Ref 2024-0720). The 4-item scale measures the perceived ability to prevent and manage falls. Participants will report their confidence levels on four items: (1) "How confident are you to walk steadily?"; (2) "How confident are you to stop yourself from falling when you lose balance?"; (3) "How confident are you to protect yourself if you fall?"; and (4) "How confident are you in getting up (from the ground) after a fall?" using a 5-point rating scale from 0 for "not at all confident" to 4 "Extremely confident". The scale has a high face and content validity and good internal consistency (α = .84).
Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
Activities Balance Confidence scale (ABC)
The ABC scale assesses older adults' confidence that they will not fall or lose their balance when performing several progressively challenging balance and mobility tasks. This scale provides a broad continuum of activity difficulty and contains situation-specific questions to determine the level of confidence in completing a task without falling or losing balance. The ABC Scale has 16 items, with answers ranging from 0% (no confidence) to 100% (complete confidence)
Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
Physical Activity Scale for the Elderly (PASE)
The PASE measures the level of self-reported physical activity in individuals aged 65 years or older. The scale has 12 items regarding occupational, household, and leisure activities during the previous 7-day period. The overall PASE score ranges from 0 to 400 or more with a higher score indicating greater level of physical activity.
Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge