Free
Poster Session
Issue Date: August 2016
Published Online: August 01, 2016
Updated: January 01, 2021
Prevalence of Frailty in Patients Receiving Occupational Therapy Services in Skilled Nursing Facilities
Author Affiliations
  • University of Pittsburgh
  • University of Pittsburgh
Article Information
Geriatrics/Productive Aging / Long-Term Care/Skilled Nursing Facilities / Assessment/Measurement
Poster Session   |   August 01, 2016
Prevalence of Frailty in Patients Receiving Occupational Therapy Services in Skilled Nursing Facilities
American Journal of Occupational Therapy, August 2016, Vol. 70, 7011500047. https://doi.org/10.5014/ajot.2016.70S1-PO4126
American Journal of Occupational Therapy, August 2016, Vol. 70, 7011500047. https://doi.org/10.5014/ajot.2016.70S1-PO4126
Abstract

Date Presented 4/8/2016

The prevalence of frailty was measured by the Survey of Health, Ageing, and Retirement in Europe Frailty Instrument (SHARE–FI) among older adults (N = 170) receiving occupational therapy services in a skilled nursing facility. Of these, 72.9% (n = 124) were frail upon evaluation. The results support occupational therapists’ use of the SHARE–FI to distinguish frailty from other clinical conditions to provide effective services.

Primary Author and Speaker: Kelly Dickson

Contributing Author: Pamela Toto

PURPOSE: The aim of this study was to determine the prevalence of frailty in skilled nursing facility (SNF) patients receiving occupational therapy using the Survey of Health, Ageing, and Retirement in Europe Frailty Instrument (SHARE–FI).
RATIONALE: It is a common misconception that frailty is a natural consequence of aging. Frailty is a complex, life-span compilation of age- and disease-related factors that leads to poor health outcomes in older adults. Given that age-related physiological decline is a contributing factor, the old-old and women are frequently considered the highest risk populations for experiencing frailty. Frailty increases older adults’ vulnerability for adverse events and puts them at great risk for experiencing disability.
Although frailty and disability in older adults are likely to co-occur and be related, frailty and disability are two distinct conditions. This distinction is not commonly assessed in geriatric rehabilitation. It is critical that occupational therapists (OTs) distinguish frailty from other clinical conditions in order to provide effective services for this high-risk population.
DESIGN: This cross-sectional prevalence study was conducted in an urban SNF from April 2014 to June 2015.
PARTICIPANTS: Participants (N = 170) were short-term patients admitted to the SNF for skilled rehabilitation.
METHOD: The SHARE–FI is a quick, valid, and reliable assessment for determining frailty in older adults. It includes five measures related to frailty conditions: weakness (assessed through grip strength using a dynamometer), exhaustion, weight loss, slowness, and physical activity (evaluated through self-report). OTs administered the SHARE–FI to patients as part of their initial evaluation. Each measure was scored as 0 with the condition’s absence or 1 with the condition’s presence. The total score ranged from 0 to 5.
ANALYSIS: Scores ≥3 were coded as “frail” and scores >3 were “not frail.” We examined frequency of frailty in the total sample, the relationship between age and frailty using the point biserial correlation, and the association between gender and frailty using the phi coefficient.
RESULTS: The average age of patients was 77 yr (range = 45–96), with 72.9% (n = 124) considered frail (SHARE–FI score of ≥3). There was no correlation between age and frailty (rpb = .043, p = .576) and no correlation between gender and frailty (φ = .096, p = .460).
DISCUSSION: Our results suggest that age-related factors may not be the primary contributor to the prevalence of frailty in SNF patients. This finding supports the use of the SHARE–FI to identify patients with frailty-related disability. The SHARE–FI allows OTs to understand patients’ capacities, formulate realistic goals, and implement interventions that match each patient’s frailty status.
IMPACT STATEMENT: With older adult population projections exceeding 72 million by 2030, reducing frailty-related disability is a quality-of-life issue and an economic necessity. To date, interventions for frail older adults have yielded mixed results. Although exercise is the most commonly used intervention for addressing frailty-related disability, systematic reviews examining the effect of exercise for frail older adults reveal poor outcomes related to disability.
In contrast, interventions aimed at directly reducing activities of daily living and instrumental activities of daily living difficulties through adaptive strategies have yielded positive outcomes including reduced disability and increase quality of life. Given this evidence and its distinct skill in facilitating participation and engagement in occupations, occupational therapy has the opportunity to become the provider of choice for reducing disability in frail older adults.