Managing Frailty After a Hospital Stay for Women Aged 65 and Older: Implications and Challenges in Rehabilitation Practice – a Narrative Review

Objective(s): • To collate current evidence on frailty interventions for women aged 65 and older after a hospital stay, focusing on targetable pathophysiological characteristics.
• To highlight the implications and challenges of sex-specific frailty management in rehabilitation practice and inform future directions.

Data Sources: A literature search of journal articles using databases PubMed and Google Scholar was done with the following search terms and phrases: “frailty in older women”, “hospitalized older women”, “frailty pathophysiology”, “sex differences”, “frailty intervention”, “physical frailty”, “psychological”, “nutritional”, “social”, “polypharmacy and frailty”. Articles published in English in the past five years until June 2024.

Study Selection: Evidence summaries, Consensus statements, Systematic reviews, Meta-analyses, Review articles, and large population-based cohort studies, that focused on frailty in older women, pathophysiological characteristics, and frailty management were selected.

Data Extraction: Data were extracted and critically appraised by two reviewers.

Data Synthesis: Out of 139 studies, 47 studies were included according to the study selection criteria. Evidence indicates that any injury or illness that leads to hospitalization poses a greater risk and progression of frailty in older women than their male counterparts. Physical frailty (weakness, wasting, slowness) is more pronounced in older women due to a greater risk of osteoporosis, sarcopenia, and obesity, contributed by inflammatory, immunosenescence, hormonal, and obstetric history. Effective management includes early mobility training, aerobics, progressive resistance training, balance activities, and fall prevention programs. Psychological factors, which are attributed to post-menopausal and age-related changes, can be addressed by cognitive therapy along with physical activity. Malnutrition, weight loss, and fatigue, which are more marked in women, can be managed with micronutrient supplementation and dietary modifications along with exercises. Social factors, which are linked with living alone or widowhood, can be approached by promoting social participation and group activities integrated with exercise and cognitive programs. Polypharmacy in older women, resulting from susceptibility to multiple chronic conditions, requires comprehensive medication review and optimization to minimize frailty.
Understanding the underlying pathophysiological mechanisms and their corresponding targeted interventions would help rehabilitation personnel provide more individualized care, avoid harm, and improve outcomes. However, the lack of concrete evidence supporting sex-specific intervention strategies, in addition to the complexity of frailty, presents substantial challenges to rehabilitation practice.

Conclusions: Integrated interventions targeting multiple domains are essential to achieve effective rehabilitation for older adult women who are frail. Future research should focus on developing and validating sex-specific rehabilitation strategies for this vulnerable population.

Author(s) Disclosures: No authors have any conflicts to disclose.