The Resilience and the Subsequent Hospitalization of Older People with Different Frailty Status: A Prospective Cohort Study

Objective To evaluate the difference in resilience across frailty status by measuring the impact of unplanned hospitalization across people with different frailty condition on (1) 2-year changes in lean mass, physical performance, and quality of life, and (2) subsequent hospitalization. Design A prospective cohort study. Setting and Participants Three thousand seventeen older people (73.7 ± 4.9 years) were recruited from the community in Hong Kong. Methods Frailty status was defined using the Cardiovascular Health Study scale at baseline. Unplanned hospitalization between the 2 visits was obtained from the Hong Kong Hospital Authority. The interaction of frailty and hospitalization status on the 2-year changes in lean mass, physical performance, and quality of life were examined using 2-way analysis of covariance. Risk of subsequent hospitalization was estimated using Poisson regression. The effect of prolonged hospitalization, which was defined as 6 or more total hospitalized days, was also examined. Results Upon unplanned hospitalization, frail older people had significantly augmented decline than prefrail and robust people in appendicular skeletal mass (−0.44 ± 0.08 kg), height-adjusted appendicular skeletal mas (−0.13 ± 0.03 kg/m2), 5-time chair-stand (4.79 ± 0.60 s), and mental health (−3.72 ± 0.88). The reduction increased with the length of hospitalization. Unplanned hospitalization conferred an augmented risk of subsequent hospitalization for those who were prefrail and frail (IRR = 1.44, 95% confidence interval = 1.30-1.59 and IRR = 1.69, 95% confidence interval = 1.45-1.97, respectively). Conclusions and Implications The resilience of older people varies according to their frailty status, and the poor resilience may translate to a higher chance of having subsequent hospitalization for prefrail and frail people. These findings emphasized the importance of having the frailty screening in making posthospitalization plans for older people depending on their frailty status and encouraging prefrail and frail older people to build up their resilience.