Abstract
BACKGROUND: Hospitals pose a high risk for frailty to develop or accelerate. Still, few community-based cohort studies follow patients before, during, and after hospitalisation. We investigated the degree of immobility during hospitalisation and its impact on subsequent frailty. METHODS: In a prospective population-based cohort of individuals aged ≥ 70 from a London UK borough, we performed comprehensive community assessments at baseline and after two years. At each hospitalisation, we measured daily mobility and other clinical variables. Acute immobility burden, a summative level of poor mobility for all hospitalisations, was calculated for each participant and operationalized as low/high based on the population median. A frailty index was calculated for all participants during baseline and follow-up assessments. We estimated the effect of these exposures on follow-up frailty index scores using linear regression. RESULTS: We included 1177 participants. Those admitted (N = 114) were assessed over 1999 bed-days. The degree of baseline frailty had the largest association with subsequent frailty. However, a high immobility burden during hospitalisation was consistently related to additional increases in frailty (low burden: β = 0.02 per unit increase in FI (95%CI: -0.002-0.04), high burden: β = 0.07, (95%CI: 0.041-0.10)). Immobility burden remained associated with subsequent frailty even when limiting the analysis to: those who were independently mobile; the first seven days of hospitalisation; and accounting for illness severity. High immobility burden was prognostic of subsequent death. CONCLUSIONS: The degree of immobility during hospitalisation, a potentially modifiable risk factor, may determine whether hospitalisation contributes to increasing frailty.