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Braun T.1,2, Thiel C.1, Ziller C.1, Rasche J.1, Hansen S.1, Grüneberg C.1
1Hochschule für Gesundheit, Department of Applied Health Sciences, Bochum, Germany, 2University of Cologne, Medical Faculty, Cologne, Germany
Background: Frailty in older people is characterized by a reduced reserve and decreased resistance to stressors [Clegg 2013]. It describes a state of high vulnerability to negative health outcomes such as falls or institutionalisation [Fried 2001]. Internationally, approximately 14% of community-dwelling older adults have physical frailty [Shamliyan 2013, Collard 2012]. Using a frailty model of deficit accumulation, the pooled prevalence of frailty is 24%. Epidemiological data of frailty in physical therapy in Europe, and Germany in particular, are limited.
Purpose: To investigate the prevalence of frailty in older people in outpatient physical therapy services in Germany.
Methods: This cross-sectional study included older adults aged 65 years and older seeking outpatient physical therapy in the municipal area of the city of Bochum, Germany. The outpatient physical therapy clinics were selected randomly. Frailty status was assessed based on the frailty phenotype model of physical frailty [Fried 2001] and the accumulation of deficit model, expressed as a frailty index [Mitnitski 2001, Searle 2008].
Results: A total number of 110 participants were recruited in five physical therapy clinics. Participants (74 ± 6 years, 57% female, BMI 28.4 ± 6.8 kg/m², 72% living with a domestic partner) main indication for physical therapy was an orthopaedic or surgical condition (75%), followed by neurological (14%) and cardio-vascular disorders (12%).
According to Frieds phenotype of physical frailty, 14.5% (95%CI: 7.9 to 21.1) participants were frail and 41.8% (95%CI: 32.6 to 51.0) were pre-frail. The frailty index identified 30.9% (95%CI: 22.3 to 39.5) individuals as frail.
Slow gait speed (33%), muscle strength (32%) and exhaustion (24%) were the most prevalent indicators of physical frailty.
Conclusion(s): Frailty is comparatively common in older people attending physical therapy care, with one out of three individuals being frail and every second individual being physically frail or pre-frail.
The prevalence of physical frailty in older people seeking physical therapy care is comparable with prevalence values in community dwelling older adults [Shamliyan 2013, Collard 2012]. Using a deficit accumulation model, frailty prevalence seems to be higher [Shamliyan 2013].
This study is limited by the relatively low number of participants recruited in a restricted urban area in western Germany.
Implications: More studies from different countries are needed to understand the prevalence of frailty among older people in physical therapy care. Aspects of physical frailty, such as slow gait speed and low muscle strength are significant contributors of frailty that can be influenced by physical therapy treatments [Ng 2015, Fairhall 2012]. Physical therapists working with frail older people should be aware of these peoples high vulnerability to negative health outcomes as well as the special health care needs required by these individuals [Clegg 2013, Turner 2014, Fairhall 2011].
Funding acknowledgements: None.
Topic: Older people
Ethics approval: Ethical Review board of the German Confederation of Physiotherapy (registration number: 2015-07)
All authors, affiliations and abstracts have been published as submitted.
