Telehealth-Supported Discharge Programme for Frail Older Adults

Telehealth-Supported Discharge Programme on Health Outcomes Among Frail Older Adults: A Pilot Randomized Controlled Trial

This pilot clinical trial aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a telehealth-supported discharge programme on physical and mental health outcomes, and healthcare utilization among community-dwelling older adults with frailty after hospital discharge.

The objectives are:

1. To determine the feasibility and acceptability of the programme by assessing participant recruitment, retention, adherence rates, and satisfaction;
2. To evaluate the preliminary effects of the programme on a) physical health outcomes (e.g., physical fitness, activities of daily living), b) mental health outcomes (e.g., depressive symptoms, perceived social support, quality of life, subjective well-being), and c) healthcare utilization (e.g., emergency department visits, hospital readmissions); and
3. To identify perceived barriers and facilitators of the programme and evaluate the acceptability and usability of gerontechnology activity sensors and pedometers for monitoring activity levels.

Community-dwelling older adults 65 years with frailty (N=50) will be recruited through a local hospital. Participants will be randomized to either the intervention or control group. The 12-week telehealth discharge support programme consists of weekly reablement-focused sessions integrating gerontechnology activity sensors and pedometers to enhance physical and mental health outcomes. Both groups will continue to receive usual care.

Descriptive statistics will be used to summarize participant data. Effect sizes will be calculated to estimate the effects of the intervention on the outcomes. Qualitative data will be analyzed using thematic analysis.

Frailty is one of the most common geriatric syndromes among older adults, and manifests as three or more of these symptoms: weight loss, fatigue, weakness, slow walking speed (<1.0m/s), and low physical activity. Characterized by multisystem physiological decline, frail older adults are at an increased risk for illnesses and poor psychosocial well-being.

Older adults with frailty are also more susceptible to hospitalization and adverse outcomes following discharge. Known as the "critical period" after hospital discharge, these individuals are at risk for unplanned emergency department visits and hospital readmissions. Further, frail older adults often experience prolonged recovery periods following hospital discharge, and may also be more sedentary, which can lead to further functional decline.

Existing evidence emphasize the need for tailored interventions to support frail older adults and address their complex, multifaceted physical and mental health needs during their transition from hospital to home. This pilot study addresses gaps in the literature by introducing a structured telehealth discharge support programme tailored to community-dwelling older adults with frailty to improve physical and mental health outcomes, reduce healthcare utilization, and enhance self-management and functional recovery. To facilitate innovation in transitional care, the programme incorporates remote health monitoring tools such as home-based gerontechnology (e.g., activity sensors) and pedometers to support physical activity and recovery.

Inclusion Criteria:

• Aged 65 years or older;
• Able to speak Cantonese;
• Meet the operational definition of frailty, which is defined as an individual who scores 3 or more on the 5-item FRAIL scale, which reflects fatigue, resistance, ambulation, illnesses, and weight loss;
• Are mentally competent according to the Abbreviated Mental Test (AMT ≥ 6);
• Discharged from an acute hospital within the last two weeks and residing at home; and
• Have access to a digital device with internet connectivity, such as a smartphone, tablet, or computer

Exclusion Criteria:

• Currently undergoing active psychiatric treatment for severe mental illness (e.g., schizophrenia, bipolar disorder) that result in serious functional impairment
• Experiencing medical conditions that contraindicate physical exercise (e.g., recent acute myocardial infarction, unstable cardiovascular pathology, fracture within the past month); and/or
• Presenting with any significant visual, language, or communication impairments that would impede their ability to meaningfully engage with the programme