Association of frailty and functional recovery in an Acute Care for Elders unit: a prospective observational study

Background Evidence on the effects of Acute Care for Elders (ACE) units in frail older adults remains limited. Therefore, we aimed to evaluate the effects of the ACE unit on functional outcomes in frail older adults. Methods In this prospective observational study, we enrolled 114 consecutive patients aged 65 years and older admitted to the ACE unit for acute medical conditions between October 2019 and September 2020. The FRAIL scale (5-question assessment of fatigue, resistance, aerobic capacity, illnesses, and loss of weight) was used to classify the patients into three groups: robust (score = 0, n = 28), prefrail (score = 1-2, n = 57), and frail (score = 3-5, n = 29). The primary outcome was the activities of daily living (ADL) measured by the Barthel Index at admission and before discharge. Paired sample t-test was employed to determine the difference in ADL. Multiple linear regression analysis, with adjustment for covariates, was conducted to examine the association between frailty status and change in ADL. Results Among 114 patients enrolled (mean age, 79.8 [+ or -] 8.1 years; mean length of stay, 6.4 [+ or -] 5.6 days), 77 (67.5%) were female. ADL at admission (60.3 [+ or -] 31.9) and before discharge (83.7 [+ or -] 21.6) were significantly different (P < 0.001). After covariates adjustment, a significant association between frailty status and change in ADL was found (prefrail vs. robust: [beta] = 9.0, 95% confidence interval [CI] 0.3-17.6, P = 0.04; frail vs. robust: [beta] = 13.4, 95% CI 2.7-24.0, P = 0.01). Conclusions Older adults with frailty experienced functional improvement after admission to the ACE unit. Prefrail and frail groups were associated with a more significant change in ADL between admission and discharge compared to the robust group. Keywords: Frailty, FRAIL scale, Functional decline, Activities of daily living, Acute Care for Elders unit