OBJECTIVE This study aimed to investigate if exercise therapy and polypharmacy was associated with frailty state transitions for home care service recipients. DESIGN Longitudinal cohort-study using client-level health information collected using interRAI home care (RAI-HC) assessments. SETTING Population-based study with Canadian home care clients in Alberta, British Columbia, Ontario and the Yukon. PARTICIPANTS Home care clients aged 65 years and older. METHODS A Markov chain multistate transition logistic regression model was used to calculate ORs for state transitions with exercise therapy and polypharmacy as independent variables. RESULTS In total, 250,428 home care clients experiencing 402,005 frailty state transitions were included in the analyses. At baseline, 39.4% of clients were categorized as nonfrail, 30.2% were categorized as prefrail, and 30.4% were categorized as frail. Nonfrail clients using polypharmacy were more likely to become prefrail (OR 1.16) and frail (OR 1.11). Pre-frail clients using polypharmacy were more likely to become frail (OR 1.06), and they were less likely to become nonfrail (OR 0.80). Frail clients using polypharmacy were significantly less likely to become prefrail (OR 0.82) or nonfrail (OR 0.62). Nonfrail clients who participated in exercise therapy were more likely to become prefrail (OR 1.05). Prefrail clients who participated in exercise therapy were more likely to become nonfrail (OR 1.26). Frail clients who participated in exercise therapy were more likely to become nonfrail (OR 1.27) and prefrail (OR 1.12). CONCLUSIONS AND IMPLICATIONS This study suggests that frailty among home care clients can be reversed. Frailty state improvement occurred significantly more often among home care clients receiving exercise therapy and significantly less often among clients with polypharmacy.

中文翻译：

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加拿大家庭护理客户的虚弱指数状况因运动疗法而改善，但因多药治疗而下降

目的 本研究旨在调查运动疗法和多种药物治疗是否与家庭护理服务接受者的虚弱状态转变有关。设计 使用通过 interRAI 家庭护理 (RAI-HC) 评估收集的客户级健康信息的纵向队列研究。SETTING 与加拿大阿尔伯塔省、不列颠哥伦比亚省、安大略省和育空地区的家庭护理客户进行的基于人口的研究。参与者 65 岁及以上的家庭护理客户。方法 采用马尔可夫链多状态转换逻辑回归模型，以运动疗法和多药治疗作为自变量计算状态转换的 OR。结果 总共有 250,428 名经历 402,005 次虚弱状态转变的家庭护理客户被纳入分析。在基线时，39.4% 的客户被归类为非体弱者，30.2% 被归类为体弱者，30.4% 被归类为虚弱。使用多种药物的非虚弱客户更有可能成为虚弱前 (OR 1.16) 和虚弱 (OR 1.11)。使用多种药物治疗的体弱前客户更有可能变得虚弱（OR 1.06），并且他们变得非虚弱（OR 0.80）的可能性更小。使用多种药物治疗的虚弱客户成为虚弱前 (OR 0.82) 或非虚弱 (OR 0.62) 的可能性要小得多。参加运动疗法的非虚弱客户更有可能成为虚弱前期（OR 1.05）。参加运动疗法的体弱前体客户更有可能变得不虚弱（OR 1.26）。参加运动疗法的体弱客户更有可能成为非虚弱 (OR 1.27) 和体弱前期 (OR 1.12)。结论和意义 这项研究表明，家庭护理客户的虚弱是可以逆转的。