Clinical trial NCT06903832: Discharge Recommendations for Older Adults Using Physical Outcome Measure
Official title: Discharge Recommendations for Older Adults Using Physical Outcome Measure (DROP)
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Discharge Planning
Older Adults (65 Years and Older)
Acute Hospitalization
OUTCOME MEASURES
Keywords: Discharge planning
Acute Hospitalization
Physical outcome measure
older adults
Gait Speed Test
Five Times Sit to Stand Test
Lead sponsor: National University Hospital, Singapore
Sponsor class: OTHER
Collaborators: name: Singapore Institute of Technology
First posted: 2025-04-01
Enrollment: 60
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Older adults admitted to inpatient wards in the National University Hospital (Singapore).

Brief summary: 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.

Detailed description: 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

Eligibility criteria: Inclusion Criteria:

* Aged 65 years and older
* Able to ambulate without physical assistance with or without walking aids as per premorbid status for at least 5 metres
* Clinical Frailty Scale (CFS) of ≤ 5
* Able to follow instructions (Abbreviated Mental Test (AMT) ≥ 5)

Exclusion Criteria:

* Admitted for acute orthopaedic or neurological conditions with physical deficits that affect functional mobility
* Requires physical assistance for functional mobility from ≥ 1 person
* Clinical Frailty Scale (CFS) of \> 5
* AMT \< 5 (Lack capacity to consent to study)

Primary outcomes:
measure: Five Times Sit To Stand Test (STS)
timeFrame: During Enrollment while admitted in acute hospital
measure: Gait Speed Test
timeFrame: During Enrollment while admitted in acute hospital
Secondary outcomes:
measure: Calf Circumference
timeFrame: During Enrollment while admitted in acute hospital
measure: Hand grip strength
timeFrame: During Enrollment while admitted in acute hospital
measure: Lower limb muscle strength using hand-held dynamometer
timeFrame: During Enrollment while admitted in acute hospital
measure: Modified Barthel Index (MBI)
timeFrame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
measure: Short Falls Efficacy Scale International (Short FES-I)
timeFrame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
measure: Balance Recovery Confidence scale (BRC)
timeFrame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
measure: Mulitdimensional Falls Efficacy Scale (MdFES)
timeFrame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
measure: Activities Balance Confidence scale (ABC)
timeFrame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
measure: Physical Activity Scale for the Elderly (PASE)
timeFrame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge
Other outcomes:
Locations:
city: Singapore
country: Singapore
facility: National University Hospital, Singapore
Study officials:
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