Discharge Recommendations for Older Adults Using Physical Outcome Measure (DROP)

April 29, 2025 updated by: National University Hospital, Singapore

Discharge Recommendations for Older Adults Using Physical Outcome Measure (DROP)

The aim of this study is to explore if the use of Sit to Stand Test and Gait speed Test could assist physiotherapist with discharge planning decisions for older adults who are admitted to an acute hospital.

Study Overview

Status

Recruiting

Conditions

Detailed Description

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

Study Type

Observational

Enrollment (Estimated)

60

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Singapore
      • Singapore, Singapore, 119074
        • Recruiting
        • National University Hospital, Singapore
        • Principal Investigator:
          • Hui Ying Koh

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Older adults admitted to inpatient wards in the National University Hospital (Singapore).

Description

Inclusion Criteria:

  • Aged 65 years and older
  • Able to ambulate without physical assistance with or without walking aids as per premorbid status for at least 5 metres
  • Clinical Frailty Scale (CFS) of ≤ 5
  • Able to follow instructions (Abbreviated Mental Test (AMT) ≥ 5)

Exclusion Criteria:

  • Admitted for acute orthopaedic or neurological conditions with physical deficits that affect functional mobility
  • Requires physical assistance for functional mobility from ≥ 1 person
  • Clinical Frailty Scale (CFS) of > 5
  • AMT < 5 (Lack capacity to consent to study)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Five Times Sit To Stand Test (STS)
Time Frame: During Enrollment while admitted in acute hospital
STS will be used to test the lower limb strength, balance control and falls risk. Participants will have to stand up and sit down five times started from a seated position, with arms across their chest. The test will have to be conducted as fast as possible using a chair with a backrest. The time taken to complete 5 repetitions will be recorded. Two trials will be performed. A cut-off score of ≥ 12s will be considered at risk of falling.
During Enrollment while admitted in acute hospital
Gait Speed Test
Time Frame: During Enrollment while admitted in acute hospital
A 4m walk test will be used to measure gait speed. Participant will walk through a 4-metre distance at comfortable speed. The time taken to complete the distance will be recorded. Two trials will be performed. Gait speed of ≤ 0.6m/s would be termed as dismobility according to Cummings et al., (2014) which would be reflected of having poor mobility and will require intervention.
During Enrollment while admitted in acute hospital

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Calf Circumference
Time Frame: During Enrollment while admitted in acute hospital
Calf circumference is a surrogate marker of muscle mass for older adults. It can be measured in sitting with the knee and ankle bent at a right angle and the feet flat on the floor. Using a measuring tape, the widest part of the part can be measured by applying the tape flat on the skin and parallel to the floor. Two measurements will be performed. A cut- off score of < 34cm in men and < 33cm in women will be consider as having low muscle mass and a higher risk of sarcopenia.
During Enrollment while admitted in acute hospital
Hand grip strength
Time Frame: During Enrollment while admitted in acute hospital
Hand grip strength measured by a hand dynamometer will be used to gauge frailty. Participant will sit in a chair with back support and asked to hold on to the dynamometer using maximum strength with the shoulder adducted and neutrally rotated, elbow flexed at 90 degrees, forearm neutral. The tested arm is not supported by examiner or armrest and the dynamometer is presented vertically and in line with the forearm. Three measurements will be performed. A cut off score of < 28kg in male and < 18kg in female is considered as having low handgrip strength.
During Enrollment while admitted in acute hospital
Lower limb muscle strength using hand-held dynamometer
Time Frame: During Enrollment while admitted in acute hospital
Reduction in quadriceps muscles strength were the most affected with aging. Muscle strength of lower limb will be assessed with knee extension strength using an electronic push/pull dynamometer. Participants would be seated with knee flexed to 90 degrees. Isometric knee strength will be measured with an electronic dynamometer attached to lower leg. A cut off score of < 23.64kg in male and < 15.24kg in female is considered as having low knee extension strength.
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
The modified barthel index (MBI) consist of 10 items of ADLS modified from Barthel index (Shah et al, 1989). This includes transfers, walking, navigating stairs, grooming, bathing, dressing, feeding, toilet transfer, bladder and bowel control. It has been validated for older adults living at home and hospitalised older adults. MBI is also commonly used to assess physical function for hospitalised older adults at admission and discharge. MBI is positively associated with functional performance even for older adults who are hospitalised. In addition, older adults with higher MBI scores and ADL independence were more likely to be discharged home post hospitalisation as well. MBI score of 0 to 24 points suggest total ADL dependency, score of 25 to 49 points suggest severe ADL dependency, score of 50 to 74 suggest moderate ADL dependency and scores above 75 suggest mild ADL dependency.
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
The Short FES-I measures the individual's concerns about falling. Seven questions were answered with a four-grade scale (1-4) of 'not at all concerned,' 'somewhat concerned,' 'fairly concerned' and 'very concerned.' The total score, which ranged from 7 to 28, was recorded. A higher score reflected a greater level of concern about falling. The Short FES-I have excellent psychometric properties and requires less time to conduct compared to the FES-I.
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
The BRC aims to measure the balance recovery confidence in community-dwelling older adults. A list of fall-related situations commonly experienced by older adults are presented to determine how certain the respondent can recover their balance to prevent a fall if the situation was to occur in the last three weeks by recording a number from 0 to 10 with 10 indicating "Highly certain can do" and 0 refers to "Cannot do at all".
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
The MdFES was developed in collaboration between NUH and SIT (ITO Ref 2024-0720). The 4-item scale measures the perceived ability to prevent and manage falls. Participants will report their confidence levels on four items: (1) "How confident are you to walk steadily?"; (2) "How confident are you to stop yourself from falling when you lose balance?"; (3) "How confident are you to protect yourself if you fall?"; and (4) "How confident are you in getting up (from the ground) after a fall?" using a 5-point rating scale from 0 for "not at all confident" to 4 "Extremely confident". The scale has a high face and content validity and good internal consistency (α = .84).
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
The ABC scale assesses older adults' confidence that they will not fall or lose their balance when performing several progressively challenging balance and mobility tasks. This scale provides a broad continuum of activity difficulty and contains situation-specific questions to determine the level of confidence in completing a task without falling or losing balance. The ABC Scale has 16 items, with answers ranging from 0% (no confidence) to 100% (complete confidence)
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
The PASE measures the level of self-reported physical activity in individuals aged 65 years or older. The scale has 12 items regarding occupational, household, and leisure activities during the previous 7-day period. The overall PASE score ranges from 0 to 400 or more with a higher score indicating greater level of physical activity.
During Enrollment while admitted in acute hospital and 2 weeks post-discharge

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National University Hospital, Singapore

Collaborators

Singapore Institute of Technology

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 1, 2025

Primary Completion (Estimated)

March 31, 2026

Study Completion (Estimated)

September 30, 2026

Study Registration Dates

First Submitted

March 28, 2025

First Submitted That Met QC Criteria

March 28, 2025

First Posted (Actual)

April 1, 2025

Study Record Updates

Last Update Posted (Actual)

April 30, 2025

Last Update Submitted That Met QC Criteria

April 29, 2025

Last Verified

March 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 2024/3331

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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