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Post-discharge follow-up assessments of frail older people in their home environment: Is it feasible?

Martin Dreilich, Anne-Marie Boström, Elisabeth Rydwik


Objectives: The aims of this study were to (1) assess the recruitment rate, drop-out, time to complete and acceptability of the test battery and evaluate the feasibility of follow-ups in the home environment and (2) describe the population in terms of sex, comorbidity, disability and frailty.

Methods: Participants were recruited from 3 geriatric departments and were assessed before discharge and in their homes at 1 and 3 months. The assessments consisted of: medical diagnoses; medications; risk of pressure ulcers, falls, malnutrition, depression and frailty; physical function, physical activity and health-related quality of life. Data on re-admission and home service were retrieved from the county council and the participating municipalities. Feasibility was evaluated by describing the recruitment process including inclusion/exclusion criteria, the participation rate and the number of and reasons for drop-out, the acceptance of the test battery, time taken and the feasibility of performing the tests in the participants’ homes.

Results: Thirty-five of 89 eligible patients agreed to participate (21 men/14 women). It took on average 70 minutes to complete the test battery at baseline and 124 minutes (including travel) at the home visits. The participants accepted the test battery. Mean age was 84 years and the women were significantly older than the men. The greatest number of the participants were regarded as frail, all had comorbidity and 77% had disability (n=27).

Conclusions: It was feasible to conduct the test battery at the ward and in the participant’s home. Frailty, comorbidity and disability were present simultaneously in almost half of the participants.


Comprehensive Geriatric Assessment (CGA), frailty, geriatric care, health outcomes, health related quality of life, person-centered healthcare, post-discharge follow-up, walking ability

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