Feasibility of a Multicomponent Frailty Intervention During Post-Acute Rehabilitation in Skilled Nursing Facilities

Although over 80% of older adults admitted to skilled nursing facilities (SNFs) for post-acute care are frail, it is unclear whether frailty interventions are feasible in this setting. We piloted a multicomponent frailty intervention in a post-acute SNF population.

We recruited community-dwelling adults ≥ 65 years old from 2 SNFs (08/2023-10/2024). We excluded those who had a feeding tube, did not have an oral diet, had chronic kidney disease (CKD) stage 4 or worse, could not consent, or were non-English-speaking. We measured demographics, comorbidities, frailty index (FI), and functional status on admission. The intervention consisted of individualized exercises and ≥ 15 g of protein supplementation within 30 min of exercise. Sessions were offered ≥ 5 times a week in addition to regular therapy. Our primary outcome was feasibility of recruitment, defined by the proportion of eligible participants enrolled.

Of 515 admissions screened, 147 were eligible and 50 enrolled (50/147 = 34.0% of eligible; 50/515 = 9.7% of screened). Mean age was 81.2 years (SD: 7.7), 34 (68%) were female, and mean prehospitalization frailty index (FI) was 0.32 (SD: 0.08). Mean SNF length of stay was 16.2 days (SD: 7.7). Overall, 55.3% of sessions offered were completed. Forty participants (80.0%) were discharged to the community, 4 (8.0%) were re-hospitalized, 4 (8.0%) transitioned to long-term care, and 2 (4.0%) had unknown discharge disposition. Eleven participants (22%) withdrew during the SNF stay. No serious adverse events occurred. Among completers (n = 34), descriptive improvements from admission to discharge included grip strength +1.4 kg (SD: 3.2), Modified Barthel Index +15.9 (SD: 16.8), AM-PAC Basic Mobility +3.6 (SD: 4.2), and PROMIS Physical Health +3.7 (SD: 7.3).

Delivering a multicomponent frailty intervention in post-acute SNFs is safe, feasible, and acceptable to older adults with frailty. These pilot data support larger trials to test efficacy and scalability.