Commentary

The desire to remain in one’s home is strong, yet the inability to care for oneself is the most common reason that frail elderly people must leave the home. In older people who have had a medical setback, rehabilitation efforts seek to improve function to keep the patient at least partially independent in the home. The study by Gill et al uses an intervention emphasising physical training as a “prehabilitation” effort to prevent or delay disability that may otherwise require institutional care.

The intervention included physical training with progressive exercises and resistive bands. The authors reported a high level of adherence to the physical training recommendation.

Conclusions from the study are mixed. On the bright side, an intervention involving assessment and physical therapy improved the functional capability of participants as measured by a self reported summary disability score. Any functional improvement, sustained over a year, is noteworthy and not easily accomplished.^1–2 In contrast, 31 participants (13 [14%] in the home based group and 18 [19%] in the educational control group) were admitted to a nursing home highlighting that frailty is difficult to prevent or overcome.

Cost effectiveness of the intervention was not fully explored in this study. The authors concede that Medicare would not cover the majority of home visits undertaken in the protocol. In addition, a further economic goal—prevention or delay in admission to costly nursing homes—was not realised.

Allocation of resources is a continuing source of tension in geriatrics. Despite positive results from the intervention, this study presents little to resolve the issue. Focusing on “prehabilitation” in the home rather than rehabilitation at a facility should show both a reduction in societal expenses and improved patient wellbeing. Perhaps focus on the selection of those patients on whom to spend resources will make the results of this study more widely applicable.