Frailty and Functional Status improvement after Skilled Nursing Facility based Post-Acute Care

Abstract People admitted to a skilled nursing facility (SNF) for post-acute care undergo comprehensive evaluation and rehabilitation, potentially enabling prediction of future functional recovery. We identified the first SNF admission per beneficiary (n=250,159) between 07/01/2014 – 06/30/2016 in a 5% Medicare sample, using the Minimum Data Set (MDS) and the Outcome and Assessment Information Set (OASIS). Episodes were excluded for non-community discharge (n=43,397) or no OASIS admission assessment within 14 days of SNF discharge (n=77,989). A deficit accumulation Frailty Index (FI) was measured on admission MDS assessment and categorized into robust (MDS-FI<0.15), pre-frailty (MDS-FI0.15-0.24), mild frailty (MDS-FI0.25-0.34), and moderate or worse frailty (MDS-FI≥0.35). Outcomes were functional decline obtained from OASIS, readmission, or death after initiation of home care. Functional status was measured by activities of daily living from OASIS assessments. A total of 135,310 SNF episodes were matched to OASIS episodes. Of these, there were 6,472 (4.8%) robust patients, 38,923 (28.8%) pre-frail, 63,727 (47.1%) mildly frail and 26,053 (19.3%) moderately frail or worse. In a logistic regression after adjustment for OASIS admission function, compared to robust status, frailty was associated with hospital readmission or death within 30 days of OASIS admission, (mild frailty OR1.33 [95%CI 1.23-1.45] and moderate or worse OR1.81 [95%CI 1.66-1.97]). Frailty was also associated with functional decline at OASIS discharge, after adjustment for OASIS admission function (mild frailty OR1.50 [95%CI 1.38-1.63] and moderate or worse OR2.30 [95%CI 2.11-2.50]). Among those discharged from SNF with home services, a SNF-based MDS-FI is associated with increased likelihood of poor community outcomes.

was 42.0%.Older adults considered frails presented lower intake of calories (1510.9kcal vs 1639.3 kcal; p = 0.016), carbohydrates (196.8 g vs 213.3 g; p = 0.011), proteins (60.7 g vs 68.5 g; p = 0.016) and fiber (15.1 g vs 17.5 g; p= 0.002).They also had lower intake of protein per kilograms of weight (0.88 g/kg vs 0.99 g/kg; p= 0.010).The findings demonstrate high prevalence of frail in our sample, and that intake of most macronutrients was significantly lower among older adults with frail, indicating the importance of the screening of frail as well the evaluation of macronutrients intake among community-based older adults, to prevent malnutrition, sarcopenia and frailty in this population.

FRAILTY IN A FRAILTY PREVENTION PROGRAM PARTICIPANTS DURING COVID-19 PANDEMIC:
A CROSS-SECTIONAL JAPANESE STUDY Takuya Kanamori, 1 Mizue Suzuki, 1 Tomoyoshi Naito, 1 Keigo Inagaki, 1 and Hiroyuki Umegaki, 2 1. Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan, 2. Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan Objective: Health conditions of older adults have deteriorated during the COVID-19 pandemic.Few studies have reported on the frailty of this group of people.The study aimed to investigate physical and social frailty in participants in a frailty prevention program during the COVID-19 pandemic.Methods: A cross-sectional survey was conducted in Japan from January 2021.Further, 863 participants of a frailty prevention program completed the survey.The frequency of program attendance in 2020, physical frailty (5-item frailty screening index), social frailty(diagnostic criteria of social frailty in NCGG-SGS), and depression (GDS-5) were assessed.A related factor of physical frailty was analyzed statistically by Welch's t test and the Chi-squared test.Results: The study participants' mean age, proportion of women, and mean enrollment period in program were 86.8±4.9, 96.3%, 64.3±48.6 months, respectively.The program attendance ratio was 83.4% from January to March, 54.5% from April to June, 79.8% from July to September, and 80.0% from October to December.The prevalence of physical frailty was 20.3% non-frailty, 63.7% pre-frailty, and 15.6% frailty.The prevalence of social frailty was 10.0% non-frailty, 28.6% social pre-frailty, 61.8% social frailty, and the prevalence of depression was 36.8%.Participants with physical frailty were significantly older and showed higher prevalence of social frailty and depression, displaying significantly lower attendance program than non-frailty and pre-frailty older adults (p<0.05).Conclusions: The study results suggest that more than half of the participants of a frailty prevention program have social frailty and a high risk of physical frailty due to COVID-19.

FRAILTY PREVALENCE AND ASSOCIATION WITH MORTALITY ACROSS BIRTH COHORTS IN SWEDISH REGISTRY DATA Alexandra Wennberg, and Karin Modig, Karolinska Institutet, Stockholm, Stockholms Lan, Sweden
Frailty is associated with poor health outcomes, reduced quality of life, and mortality.To understand how prevalence of frailty may have changed across birth cohorts, we investigated frailty prevalence at ages 75, 85, and 95 in people born in 1910, 1920, and 1930 in Swedish national registry data.Frailty was assessed with the Hospital Frailty Risk Score, a weighted sum of 109 ICD codes, which we calculated for each year leading up to the specified ages.We additionally investigated the association between frailty and mortality in these birth cohorts.We observed, at 75, a decrease in prevalence of frailty across birth cohorts (16.9%, 10.8%, and 8.8%, respectively).Interestingly, at 85, we found a U-shaped pattern, where those born in 1920 (14.1%) had lower prevalence of frailty than those born in either 1910 (27.7%) or 1930 (25.1%).At age 95, we saw a low prevalence of frailty in the 1910 (7.3%) and 1920 (3.8%) birth cohorts -potentially because of selective survival.There were not substantial differences in prevalence of frailty by sex or birth country.In Cox proportional hazard models adjusted for sex, frailty was consistently associated with mortality.We observed the greatest hazard ratios in the 1930 birth cohort at 75 (HR=2.79,95% CI 2.62, 2.97) and 85 (HR=2.26,95% CI 2.01, 2.53) and the 1920 birth cohort at 75 (HR=2.19,95% CI 2.09, 2.29), where risk was double that of those who were not frail.Understanding changes in prevalence of frailty will help inform public health and intervention measures.Frailty predicts readmissions and mortality after acute hospitalizations.Understanding whether frailty predicts functional recovery after acute hospitalizations may help guide post-acute care and rehabilitation.This feasibility study enrolled 24 adults aged ≥65 years from a skilled nursing facility (SNF) after acute hospitalization.We calculated a deficit-accumulation frailty index (FI range: 0-1; nonfrail [≤0.25], mild frailty [0.26-0.35],moderate [0.36-0.45],and severe [>0.45]) via in-person assessment on SNF admission.We measured weekly functional improvement with modified Barthel Index, as well as quality of life.Modified Barthel Index and quality of life were measured weekly by Patient-Reported Outcome Measurement Information System (PROMIS) (standardized score with mean 50 and SD 10, higher is better).The mean age was 83.3 years [SD 8.0], and 17 (71.8%)were female.Length of stay for those with severe frailty (FI>0.45)was 26.8 days [10.7] compared to those who were not frail, mildly frail, or moderately frail (13.3 [7.3], 9.4 [4.4], and 15.2 [4.9] respectively).Those with severe frailty also had delayed functional improvement (mean Barthel Index 48.6,53.4,and 56.6 on admission, week 1, and week 2 of SNF admission respectively), compared to those with moderate frailty (mean Barthel Index 47.5, 69, 73) or mild frailty (68.3, 86, 90.5).Self-reported mental and physical health-related quality of life was relatively unchanged across SNF episode for all frailty categories.These findings suggest that older adults with moderate or severe frailty may experience a typical course of delayed functional recovery and that further monitoring may be necessary for prognostication.

MALNUTRITION-SARCOPENIA SYNDROME AND ITS ASSOCIATED FACTORS AMONG OLDER ADULTS Murad Taani, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States
Malnutrition and sarcopenia are present in parallel in older adults and characterized by a combination of inadequate nutrient intake and decreased muscle mass, strength, and/or function.The presence of both conditions has been termed Malnutrition-Sarcopenia Syndrome (MSS) and is associated with negative health outcomes.The objective of this correlational study was to identify the prevalence and factors associated with the malnutrition-sarcopenia syndrome among older adults living in continuing care retirement communities.A convenience sample of 104 older adults living in CCRCs participated in this study.Muscle mass, strength, and function were measured using bioimpedance analysis, Jamar digital hand dynamometer, and the Short Physical Performance Battery test, respectively.Physical activity, sedentary time, and nutritional status were measured using ActiGraph GT3X and Mini Nutritional Assessment, respectively.Questionnaires were used to measure self-efficacy for exercise and goal congruence for physical activity and protein intake.Of the 104 participants, 37 (35.2%) had sarcopenia, 19 (18.1%) had malnutrition, and 14 (13.5 %) had MSS.Compared with those without MSS, older adults with MSS were more than two times more likely to have a sedentary lifestyle (Odd ratio, 2.028; 95% confidence interval, 2.012-2.044).Findings showed that sarcopenia, malnutrition, and MSS are prevalent in older adults living in continuing care retirement communities.Older adults should be screened and assessed for both malnutrition and sarcopenia.The results also suggest that decreasing the sedentary time could help in preventing MSS among older adults living in continuing care retirement communities.

OUTCOMES OF A TELEPHONE-BASED FRAILTY AND FUNCTIONAL ASSESSMENT
Stephanie Denise Sison, 1 Karla Tejada Arias, 2 Natalie Newmeyer, 3 Racheli Schoenburg, 2 Carolina Fonseca Valencia, 4 and Dae Kim, 5 1.Beth Israel Deaconess Medical Center / VA Boston New England GRECC,Boston,Massachusetts,United States,2. BIDMC,Boston,Massachusetts,United States,3. Marcus Institute for Aging Research,Boston,Massachusetts,United States,4. BIDMC,Providence,Rhode Island,United States,5. Hebrew SeniorLife,Boston,Massachusetts,United States With the goal of increasing the clinical use of frailty, we piloted a quality improvement project to determine the feasibility and utility of a telephone-based frailty and functional assessment.We identified 122 established patients with serious medical illness from an academic geriatrics clinic.A geriatric fellow assessed the functional status and conducted the Mini Nutritional Assessment, telephone-MoCA, and Geriatric Depression Scale to generate a deficit-accumulation frailty index (FI) score which was automatically calculated through the electronic medical record.A note was then generated to inform the providers of the details of the assessment and to provide recommendations based on the findings.From November 2020 to March 2021, 104 out of 122 (85.2%) established patients (mean [SD]: 83.4 [7.1], 66% female, 81% White, and mean [SD] FI: 0.32 [0.17]) agreed and proceeded Sandra Shi, 1 Brianne Olivieri-Mui, 2 Ellen McCarthy, 2 and Dae Hyun Kim, 2 1. Hebrew SeniorLife, Harvard Medical School, Roslindale, Massachusetts, United States, 2. Hebrew SeniorLife, roslindale, Massachusetts, United States