Written by Heather Block, FORTRESS project coordinator, occupational therapist and PhD candidate.
Frailty is prevalent in up to 80% of hospitalised older people. Frailty is associated with increased risk of falls, longer length of stay in hospital, increased risk of institutionalisation and death. Frailty can be measured using a range of validated tools and individualised treatment can improve frailty status.
The Asia Pacific clinical practice guidelines for the management of frailty provide the following recommendations:
- Use validated tools to identify frailty,
- Physical activity incorporating resistance training,
- Address polypharmacy,
- Provide nutrition support,
- Screen for reversible causes of fatigue,
- Vitamin D supplementation.
These guideline recommendations do not implement themselves, and there is a need to increase the use of comprehensive, integrated care to better manage patients with frailty to increase healthy ageing in the older population.
Frailty in Older People: Rehabilitation Treatment Research Examining Separate Settings (FORTRESS) is a multi-site, hybrid type II, stepped wedge, cluster, randomised trial being conducted at Southern Adelaide Local Health Network, and Hornsby Ku-ring-gai Hospital, Sydney. The study will investigate if a multicomponent intervention for frail older people, commenced in hospital and continued in the community, will reduce hospital readmissions, reduce frailty and improve quality of life. Frail older people admitted to study wards with no significant cognitive impairment, who are expected to return home after discharge, will be eligible to participate. Participants will receive extra sessions of physiotherapy, pharmacy, and dietetics during their admission. A Community Implementation Facilitator will coordinate implementation of the frailty management strategies and liaison with GPs and practice nurses for longer-term frailty management.
As part of FORTRESS, frailty education sessions have been conducted to GPs and practice nurses to raise awareness of frailty screening, frailty interventions and incorporating frailty management plans into primary care.
FORTRESS recruitment and intervention stages have finished at SALHN, but continue at the Sydney site until 2023. To date, over 400 frail older people have been included in the FORTRESS study. If the FORTRESS intervention provides a clinically significant and cost-effective result, it will demonstrate an improved approach to treating frail patients, both in hospital and when they return home.
For more information on the FORTRESS study, you can read the protocol here: Frailty in older people: Rehabilitation Treatment Research Examining Separate Settings (FORTRESS): protocol for a hybrid type II stepped wedge, cluster, randomised trial | BMC Geriatrics | Full Text (biomedcentral.com)
You can also see a presentation on FORTRESS during the RePaDD Lunchtime Seminar Series: https://blogs.flinders.edu.au/repadd/2022/08/16/frailty-in-older-people-rehabilitation-treatment-research-examining-separate-settings-fortress/
Heather Block, FORTRESS project coordinator