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

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.