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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.