The prevalence of frailty among geriatric hospital inpatients, and the feasibility of adapted exercise interventions for geriatric hospital inpatients, and assisted living facility residents with frailty

The world’s population is ageing, and most older adults experience a latter phase of life burdened with disease and illness. Frailty is a common, and clinically significant condition among geriatric populations, associated with hospitalisation, disability, and mortality. The absolute prevalence, and overall burden of frailty, is projected to increase substantially in the coming decades as the population ages. Exercise interventions have been proposed as potentially offering the best treatment for frail older adults. However, relatively little is known regarding the prevalence of frailty among geriatric hospital inpatients; the association between the prevalence of frailty and national economic indicators; or the feasibility of exercise interventions for frail populations within different settings. In this PhD, a systematic review and meta-analysis were conducted to elucidate the prevalence of frailty and pre-frailty among geriatric hospital inpatients, and the association between the prevalence of frailty and national economic indicators. Further, utilising a mixed methods approach, the feasibility of a potential future clinical trial, aimed at assessing the impact of exercise interventions among frail geriatric populations within a delayed discharge hospital ward, and assisted living facility setting, was examined. A systematic review and subsequent meta-analysis of ninety-six eligible studies, comprising a pooled sample of n=467,779 geriatric hospital inpatients, revealed an overall pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients of 47.4% and 25.8%, respectively. Stratified analyses illustrated frailty was more prevalent among those aged ≥ 85 years; residing on rehabilitation wards; assessed using the Groningen frailty indicator, and patients classified as rehabilitation or delayed discharge. No significant differences were observed in pooled prevalence estimates of frailty stratified by sex or geographic location. Further, no significant associations were observed between the prevalence of frailty and national economic indicators. Mixed methods analysis regarding the feasibility of exercise interventions among geriatric delayed discharge hospital inpatients found impracticalities regarding the dynamics of the setting, and the profile of patients within the setting, which resulted in the interpretation of a future clinical trial being largely unfeasible within a delayed discharge hospital ward setting. Feasibility analysis further revealed a study of this nature is likely best suited primarily in more stable environments, such as transitional care facilities, assisted living facilities, or nursing home settings, or in the increasing ‘hospital at home’ settings. Overall, the findings of this thesis provide several novel and practically useful findings, and resources which will aid future research and policy planning in this increasingly important field of research, which, if present demographic trends persist, will continue to grow in contemporary and future importance as the world’s population ages