Discharge Recommendations for Older Adults Using Physical Outcome Measure

Older adults are susceptible to acute illnesses which could predispose them to hospital admissions, with some of the common reasons for admission being infections, exacerbations of chronic conditions, and falls. This higher likelihood of older adults admitted to hospitals can be seen from the statistics from Ministry of Health in 2021 whereby older adults aged 65 years and older constitute up to 287.3 admissions per 1000 resident population, which is the highest among all age groups. In a study exploring the trend of injuries sustained by older adults presented to the Emergency Department of an acute hospital, 85.3% of all injuries sustained by older adults were due to falls. Common physical injuries sustained by older adults after a fall are fractures, bruises, and soft tissue injuries. Functional decline after a fall was also relatively common in older adults. Additionally, it has also been well recognized that hospitalisation may cause older adults to experience deconditioning. Therefore, older adults who are admitted to an acute hospital, especially those who are admitted due to falls or have a history of falls, are generally at high risk of having a change in their functional status. For the older adults with a change in functional status and have been assisted by a caregiver prior to their hospital admission, one of the main aims usually would be to make sure that their caregivers are still competent in caring for them after discharge. However, for older adults whose premorbid physical functional status are relatively independent, it is pertinent to establish if they are still safe to manage their own care after discharge from hospital. Proper discharge planning for this group of older adults is important to make sure that those who are discharge home will not experience functional decline or at increased risk of falls. Older adults who are admitted in an acute hospital are commonly referred to physiotherapists for assessment to determine are ready to return home or if they need further rehabilitation. However, to manage high workload in the acute hospital and space constraints in the wards, these older adults' readiness for home are frequently based on physiotherapists' clinical judgement, which may differ based on their clinical experience. Discharge planning is predominantly based on the comparisons between the older adults' self-reported functional mobility before hospital admission and the level of assistance they require during assessment by inpatient physiotherapists. Without the use objective outcome measures, there may be disagreement by medical team or family members on physiotherapist's recommendations. Furthermore, there is no venue to track the older adult's improvement objectively. STS and GST are two functional outcome measures that are validated to measure different physical aspects of older adults. STS has been shown to be able to assess lower limb strength, balance control and falls risk. This can be seen from the recommended use of STS in the acute setting for the assessment of lower limb strength and physical performance by a Singapore multidisciplinary consensus recommendation on muscle health in older adults by Chew et al. (2021). As for GST, it is reflective of a person's functional mobility whereby a study by Ostir et al., (2015) has demonstrated that GST can be used as a simple and quick screening tool for hospitalised older adults who may require further intervention with their mobility. As these two measures are easy to administer, less time-consuming and do not require much space, they may be suitable outcome measures to facilitate discharge planning. However, there is no literature demonstrating that they have been used to facilitate discharge planning for older adults in acute hospitals. Therefore, the primary aim of this study is to explore if the two outcome measures are useful in facilitating discharge planning for older adults who are admitted to an acute hospital. Our secondary aim is to determine if the discharge recommendations for participants to discharge home are accurate by looking for any change in the basic activity of living (ADL), self-reported fear of falls and activity confidence post-discharge

• Calf Circumference [Time frame: During Enrollment while admitted in acute hospital]
• Hand grip strength [Time frame: During Enrollment while admitted in acute hospital]
• Lower limb muscle strength using hand-held dynamometer [Time frame: During Enrollment while admitted in acute hospital]
• Modified Barthel Index (MBI) [Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge]
• Short Falls Efficacy Scale International (Short FES-I) [Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge]
• Balance Recovery Confidence scale (BRC) [Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge]
• Mulitdimensional Falls Efficacy Scale (MdFES) [Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge]
• Activities Balance Confidence scale (ABC) [Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge]
• Physical Activity Scale for the Elderly (PASE) [Time frame: During Enrollment while admitted in acute hospital and 2 weeks post-discharge]