Skip to main content
SpringerLink
Log in

Frailty Related Factors as Predictors of Functional Recovery in Geriatric Rehabilitation: The Sarcopenia and Function in Aging Rehabilitation (SAFARI) Multi-Centric Study

  • Published:
The journal of nutrition, health & aging

Abstract

Background

Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation.

Objective

The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults.

Design

Multi-centric cohort study.

Participanst and Settings

Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016.

Measurements

The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission.

Results

We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an orthopedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additionally, in both diagnostics groups, a better handgrip strength increased the chance of RFG.

Conclusions

Among frailty-related variables, physical, cognitive and muscular function at admission could be relevant for functional improvement during geriatric reha-bilitation. If confirmed, this data might orient targeted interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Table 1
Table 2
Table 3
Table 4
Table 5
Table 7

Similar content being viewed by others

References

  1. Morley JE, Vellas B, Abellan Van Kan G, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14:392–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Clegg A, Young J, Iliffe S et al. Frailty in elderly people. Lancet 2013; 381:752–62.

    Article  PubMed  Google Scholar 

  3. Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortali-ty. J Am Geriatr Soc 2013; 61:1537–51.

    Article  PubMed  Google Scholar 

  4. Fried LP, Tangen CN, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56:146–56.

    Article  Google Scholar 

  5. Whitson HE, Purser JL, Cohen HJ. Frailty thy name is᾿Phrailty? J Gerontol A Biol Sci Med Sci 2007; 62:728–30.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bachmann S, Finger C, Huss A, et al. Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 2010; 340:c1718.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Onder G, Penninx BW, Ferrucci L, et al. Measures of physical performance and risk for progressive and catastrophic disability: results from the women’s health and aging study. J Gerontol A Biol Sci Med Sci 2005; 60:74–79.

    Article  PubMed  Google Scholar 

  8. Buntin MB, Colla CH, Deb P, et al. Medicare spending and outcomes after postacute care for stroke and hip fracture. Med Care 2010; 48:776–84.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bellelli G, Mazzola P, Morandi A, et al. Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc. 2014; 62:1335–40

    Article  PubMed  Google Scholar 

  10. Formiga F, Navarro M, Duaso E et al. Factors associated with hip fracture-related falls among patients with a history of recurrent falling. Bone 2008; 43: 941–44

    Article  PubMed  Google Scholar 

  11. Krishnan M, Beck S, Havelock W, et al. Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing. 2014; 43:122–26

    Article  PubMed  Google Scholar 

  12. Landi F, Onder G, Cesari M, et al. Functional decline in frail community-dwelling stroke patients. Eur J Neurol 2006; 13:17–23.

    Article  PubMed  CAS  Google Scholar 

  13. Amblàs-Novellas J, Espaulella-Panicot J, Inzitari M, et al. En busca de respuestas al reto de la complejidad clínica en el siglo XXI: A propósito de los índices de fragilidad. Rev Esp Geriatr Gerontol. 2016; https://doi.org/10.1016/j.regg.2016.07.005, pii:S0211-139X (16)30104-4.

    Google Scholar 

  14. Scherbakov N, Sandek A, Doehner W. Stroke-related sarcopenia: specific characteristics. J Am Med Dir Assoc 2015; 16:272–6.

    Article  PubMed  Google Scholar 

  15. Ricci E, Guerini F, Bellelli G, Trabucchi M. Rehabilitation of older adults with hip frac-ture: cognitive function and walking abilities. J Am Geriatr Soc 2011; 59:1497᾿02.

    Article  PubMed  Google Scholar 

  16. Gotor P, Queipo R, Velasco R, et al. Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome. Geriatr Gerontol Int 2016; 16:1021᾿7.

    Article  PubMed  Google Scholar 

  17. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373᾿3.

    Article  PubMed  CAS  Google Scholar 

  18. Rubenstein LZ, Harker JO, Salvà A, et al. Screening for under nutrition in geriatric practice: developing the Short- Form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56: M366᾿2.

    Article  PubMed  CAS  Google Scholar 

  19. Folstein MF, Folstein SE, McHugh PR. MiniMental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189᾿8.

    PubMed  CAS  Google Scholar 

  20. Inouye SK, Van Dyck CH, Alessi CA, et al. Clarifying confusion: The Confusion As-sessment Method. A new method for detection of delirium. Ann Intern Med 1990; 113:941᾿8.

    PubMed  CAS  Google Scholar 

  21. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing 2010; 39: 412᾿3.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bosaeus I, Wilcox G, Rothenberg E, Strauss BJ. Skeletal muscle mass in hospital-ized elderly patients: comparison of measurements by single-frequency BIA and DXA. Clin Nutr 2014; 33: 426᾿1.

    Article  PubMed  Google Scholar 

  23. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000; 89:465᾿1.

    Article  PubMed  CAS  Google Scholar 

  24. Mahoney FI, Barthel DW. Funtional evaluation: The Barthel index. Md State Med J 1965; 14: 61᾿5.

    PubMed  CAS  Google Scholar 

  25. Koh GC-H, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open 2013; 3: e003483.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Heinemann AW, Roth EJ, Cichowski K, et al. Multivariate analysis of improvement and outcome following stroke rehabilitation. Arch Neurol 1987; 44:1167–72.

    Article  PubMed  CAS  Google Scholar 

  27. Pérez LM, Inzitari M, Quinn TJ, et al. Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study. PLoS One 2016 Nov 9; 11(11):e0166304.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Miralles R, Muniesa JM, Mojal S, et al. Three measures of physical rehabilitation effectiveness in elderly patients: a prospective, longitudinal, comparative analysis. BMC Geriatr 2015 Oct 29; 15:142.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Baztán JJ, Gálvez CP, Socorro A. Recovery of functional impairment after acute illness and mortality: One-Year follow-up study. Gerontology 2009; 55:269–74.

    Article  PubMed  Google Scholar 

  30. Pérez LM, Inzitari M, Roqué M, et al. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia. Neurol Sci. 2015; 36: 1875–80.

    Article  PubMed  Google Scholar 

  31. Morghen S, Morandi A, Guccione AA, et al. The association between patient participation and functional gain following inpatient rehabilitation. Aging Clin Exp Res 2017; 29:729–36.

    Article  PubMed  Google Scholar 

  32. Morghen S, Gentile S, Ricci E, et al. Rehabilitation of older adults with hip fracture: Cognitive function and walking abilities. J Am Geriatr Soc 2011;59:1497–502.

    Article  PubMed  Google Scholar 

  33. Inouye M, Kishi K, Ikeda Y et al. Prediction of functional outcome after stroke rehabilitation. Am J Phys Med Rehabil. 2000;79:513–18.

    Article  PubMed  CAS  Google Scholar 

  34. Peel NM, Navanathan S, Hubbard RE. Gait speed as a predictor of outcomes in postacute transitional care for older people. Geriatr Gerontol Int 2014; 14:906–10

    Article  PubMed  Google Scholar 

  35. Fritz S, Lusardi M. White paper:“walking speed: the sixth vital sign᾿J Geriatr Phys Ther 2009; 32:2–5

  36. Abellan Van Kan G, Rolland Y, Andrieu S et al. Gait speed at usual pace as a predic-tor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 2009; 13: 881–9.

    Article  PubMed  CAS  Google Scholar 

  37. Sánchez-Rodríguez D, Marco E, Miralles R, et al. Sarcopenia, physical rehabilitation and functional outcomes of patients in a subacute geriatric care unit. Arch Gerontol Ge-riatr 2014; 59:39–43.

    Article  Google Scholar 

  38. Bianchi L, Abete P, Bellelli G, et al. GLISTEN Group Investigators. Prevalence and Clinical Correlates of Sarcopenia, Identified According to the EWGSOP Definition and Diagnostic Algorithm, in Hospitalized Older People: The GLISTEN Study. J Gerontol A Biol Sci Med Sci 2017 Jan 21. doi: 10.1093/gerona/glw343

    Google Scholar 

  39. Morandi A, Onder G, Fodri L, et al. The association between the probability of sar-copenia and functional outcomes in older patients undergoing in-hospital rehabilitation. J Am Med Dir Assoc 2015; 16:951–56.

    Article  PubMed  Google Scholar 

  40. Di Monaco M, Castiglioni C, De Toma E, et al. Handgrip strength is an independent predictor of functional outcome in hip-fracture women: a prospective study with 6-month follow-up. Medicine (Baltimore) 2015; 94: e542.

    Article  Google Scholar 

  41. Inouye M, Kishi K, Ikeda Y et al. Prediction of functional outcome after stroke rehabilitation. Am J Phys Med Rehabil. 2000; 79:513–18.

    Article  PubMed  CAS  Google Scholar 

  42. Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiolo-gy, clinical presentation, medical care, and outcomes. Lancet Neurol 2008; 7: 915–26.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Arber S, Cooper S. Gender differences in later life: the new paradox. Soc Sci Med 1999; 48:61–76.

    Article  PubMed  CAS  Google Scholar 

  44. Cary MP, Jr, Merwin EI, Oliver MN, Williams IC. Inpatient rehabilitation outcomes in a national sample of Medicare beneficiaries with hip fracture. J Appl Gerontol 2014

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Parc Sanitari Pere Virgili, Esteve Terradas Nº30, 08023, Barcelona, Spain

    Alicia Calle, L. M. Pérez, M. Mesas, N. Martínez & M. Inzitari

  2. RE-FiT Barcelona research group, Vall d’Hebrón Institute of Research (VHIR), Barcelona, Spain

    Alicia Calle, L. M. Pérez, M. Mesas & M. Inzitari

  3. Department of Medicine, Universistat Autònoma de Barcelona, Barcelona, Spain

    Alicia Calle & M. Inzitari

  4. IRCC Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy

    G. Onder & E. Ortolani

  5. Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy

    A. Morandi, G. Bellelli, A. Sanniti, P. Mazzanti, C. N. Platto & S. Gentile

  6. School of Medicine and Surgery, University Milano-Bicocca, Milan, Italy

    A. Morandi, G. Bellelli, A. Sanniti, P. Mazzanti, C. N. Platto & S. Gentile

  7. Fundació Salut i Envelliment de la UAB, Barcelona, Spain

    M. Roquè

Authors
  1. Alicia Calle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Onder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Morandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Bellelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Ortolani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. M. Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Mesas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Sanniti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P. Mazzanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C. N. Platto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Gentile
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. N. Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Roquè
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. M. Inzitari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alicia Calle.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calle, A., Onder, G., Morandi, A. et al. Frailty Related Factors as Predictors of Functional Recovery in Geriatric Rehabilitation: The Sarcopenia and Function in Aging Rehabilitation (SAFARI) Multi-Centric Study. J Nutr Health Aging 22, 1099–1106 (2018). https://doi.org/10.1007/s12603-018-1060-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-018-1060-2

Key words

Search

Navigation