Frailty in older people: rehabilitation treatment research examining separate settings Plus (FORTRESS Plus): Results of a single-arm intervention study with comparison to historical controls
Year: 2026
Type: preprint
Study design: Clinical Trial
Abstract: Background Frail older adults hospitalised with acute illness are at high risk of functional decline, yet few receive intensive multidisciplinary rehabilitation during admission or after discharge. FORTRESS Plus was a single-arm study of a multicomponent frailty intervention comprising comprehensive geriatric assessment, pharmacy review, dietetic support, and up to seven weekly supervised home-based exercise sessions after discharge, compared with historical controls from the FORTRESS study, whose post-discharge support was limited to one to two home visits and weekly telephone calls. Methods 141 participants were recruited from three wards at Hornsby Ku-ring-gai Hospital, Sydney, Australia, between October 2023 and July 2024. The primary analysis compared 118 FORTRESS Plus participants meeting FORTRESS eligibility criteria (age ≥ 75, Mini Mental State Examination (MMSE) ≥ 24) with 110 FORTRESS historical controls. Health-related quality of life (EQ-5D-5L index and Visual Analogue Scale (VAS)) was assessed at baseline, 4 months, and 12 months. Secondary outcomes included physical function, mood, readmissions, social support, and medication burden. Results Compared with historical controls, FORTRESS Plus participants had higher adjusted EQ-5D-5L index scores at 4 months (difference 0.22, 95% CI 0.12 to 0.32) and 12 months (difference 0.24, 95% CI 0.13 to 0.35; time-by-study interaction p < 0.0001 at both times). An average treatment effect of 0.17 (95% CI 0.01 to 0.34) was estimated after assigning an EQ-5D-5L index value of − 1 to participants who died before 12 months. Within FORTRESS Plus, physical function and mood improved: Short Physical Performance Battery (SPPB) scores increased by 1.71 points at 4 months and 2.47 points at 12 months, and Geriatric Depression Scale (GDS-15) scores decreased by 1.10 and 1.87 points, respectively (all p < 0.05). Readmissions did not differ significantly between studies. Conclusion The more intensive multicomponent intervention in FORTRESS Plus was associated with a clinically meaningful improvement in health-related quality of life compared with the less intensive FORTRESS intervention. Physical function and mood also improved within FORTRESS Plus. Trial Registration : The study was approved by the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH00649) and received site-specific governance approval (2023/STE01740). Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12623001103651, registered 20 October 2023.
Source: Research Square
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225050042