Gait speed and frailty status in relation to adverse outcomes in geriatric rehabilitation

Publication date: Available online 9 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Aparna Arjunan, Nancye M. Peel, Ruth E. Hubbard

Abstract

Objective

Both slow gait speed and higher levels of frailty are associated with adverse outcomes in community-dwelling older people. However these measures are not routinely utilised to stratify risk status in the hospital setting. Here we assessed their predictive validity in older inpatients.

Design, Setting and Participants

Participants 65 years and older were included in a prospective cohort study conducted in inpatient rehabilitation wards of a tertiary hospital.

Interventions

A frailty index (FI) was calculated from routinely collected data and gait speed (GS) was determined from a timed ten metre walk test.

Outcome measures

Adverse outcomes were longer length of stay (≥75th percentile), poor discharge outcome (discharge to a higher level of care or inpatient mortality) and inpatient delirium and falls.

Results

Of 258 participants recruited, mean (SD) age was 79 (8) and 54% were female. Mean (SD) FI on admission was 0.42 (0.13) and an FI could be derived in all participants. Mean (SD) GS was 0.26 (0.33) m/sec. Those unable to complete a timed-walk on admission (50%) were allocated a gait speed of zero. There was a weak but significant inverse relationship between FI and gait speed (correlation coefficient -0.396). Both parameters were significantly associated with longer length of stay (p<0.001), poor discharge outcome (p≤0.001) and delirium (p<0.05).The prevalence of adverse outcomes was highest in the cohort who were more frail and unable to mobilise at admission to rehabilitation.

Conclusions

FI and GS each showed predictive validity for adverse outcomes. In a geriatric rehabilitation setting, they measure different aspects of vulnerability and combining the two may add value in identifying patients most at risk.

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