Discharge Recommendations for Older Adults Using Physical Outcome Measure

Five Times Sit To Stand Test (STS)

STS will be used to test the lower limb strength, balance control and falls risk. Participants will have to stand up and sit down five times started from a seated position, with arms across their chest. The test will have to be conducted as fast as possible using a chair with a backrest. The time taken to complete 5 repetitions will be recorded. Two trials will be performed. A cut-off score of ≥ 12s will be considered at risk of falling.

Gait Speed Test

A 4m walk test will be used to measure gait speed. Participant will walk through a 4-metre distance at comfortable speed. The time taken to complete the distance will be recorded. Two trials will be performed. Gait speed of ≤ 0.6m/s would be termed as dismobility according to Cummings et al., (2014) which would be reflected of having poor mobility and will require intervention.

Calf Circumference

Calf circumference is a surrogate marker of muscle mass for older adults. It can be measured in sitting with the knee and ankle bent at a right angle and the feet flat on the floor. Using a measuring tape, the widest part of the part can be measured by applying the tape flat on the skin and parallel to the floor. Two measurements will be performed. A cut- off score of \< 34cm in men and \< 33cm in women will be consider as having low muscle mass and a higher risk of sarcopenia.

Hand grip strength

Hand grip strength measured by a hand dynamometer will be used to gauge frailty. Participant will sit in a chair with back support and asked to hold on to the dynamometer using maximum strength with the shoulder adducted and neutrally rotated, elbow flexed at 90 degrees, forearm neutral. The tested arm is not supported by examiner or armrest and the dynamometer is presented vertically and in line with the forearm. Three measurements will be performed. A cut off score of \< 28kg in male and \< 18kg in female is considered as having low handgrip strength.

Lower limb muscle strength using hand-held dynamometer

Reduction in quadriceps muscles strength were the most affected with aging. Muscle strength of lower limb will be assessed with knee extension strength using an electronic push/pull dynamometer. Participants would be seated with knee flexed to 90 degrees. Isometric knee strength will be measured with an electronic dynamometer attached to lower leg. A cut off score of \< 23.64kg in male and \< 15.24kg in female is considered as having low knee extension strength.

Modified Barthel Index (MBI)

The modified barthel index (MBI) consist of 10 items of ADLS modified from Barthel index (Shah et al, 1989). This includes transfers, walking, navigating stairs, grooming, bathing, dressing, feeding, toilet transfer, bladder and bowel control. It has been validated for older adults living at home and hospitalised older adults. MBI is also commonly used to assess physical function for hospitalised older adults at admission and discharge. MBI is positively associated with functional performance even for older adults who are hospitalised. In addition, older adults with higher MBI scores and ADL independence were more likely to be discharged home post hospitalisation as well. MBI score of 0 to 24 points suggest total ADL dependency, score of 25 to 49 points suggest severe ADL dependency, score of 50 to 74 suggest moderate ADL dependency and scores above 75 suggest mild ADL dependency.