Rehabilitative physical therapy may better prevent functional dependence and increased frailty than certain home care services, a study in at-risk older adults has found.

The researchers determined the prevalence of frailty in older Connecticut adults who enrolled in Medicaid home- and community-based services, or HCBS, programs between 2017 and 2020. They also sought to gauge which services were most effective addressing the condition.

Study participants either required skilled nursing care or had significant functional limitations but did not yet meet that care threshold, said lead author Tiffany Tsay, MPH, of the Virginia Commonwealth University School of Medicine. Using a frailty index calculated with data from Connecticut’s Universal Assessment Tool (based on InterRAI-HC), she and her colleagues found that 58% of the state’s older HCBS population met the resulting definition of frailty, and 22% qualified as pre-frail. 

At an eight-month minimum follow-up, fully 43% of study participants experienced significant decline, and 12% experienced clinically meaningful improvements in their frailty scores.

Health services were tied to outcomes, Tsay reported. Participants who used home nurse services were more likely to decline than those who did not have home nurse services, for example. In addition, those who received in-home care services such as a home health aide were 36% less likely to show frailty improvement, the researchers wrote.

In contrast, frail older adults who received physical therapy services were 1.4 times as likely to have improved frailty index scores than those who did not. 

The findings suggest that there is room for change in even a frail population, and the nature of health services provided can make a big difference, the researchers said. 

“Having personal care or home nurse services could potentially contribute to functional dependence and frailty decline, while rehabilitative services such as physical therapy could provide targeted supports that protect against decline,” Tsay wrote. But the use of physical therapy is predominantly limited to the already frail population, she noted.

More states now use frailty tools to prioritize care for individuals who are most likely to require institutional care or high service usage, the researchers said. The next step may be to explore the efficacy of physical therapy as a preventive tool among non-frail individuals and how in-home care may be contributing to increased frailty, they concluded.

The authors won the top poster presentation award for their study at AMDA–The Society for Post-Acute and Long-Term Care Medicine’s PALTC21 Virtual Annual Conference.

The article was published in JAMDA.