Fall 2025

Fall 2025 Issue

Rehabilitation: Rehabilitating the Frail
By Mark D. Coggins, PharmD, BCGP, FASCP
Today’s Geriatric Medicine
Vol. 18 No. 4 P. 5

Frailty syndrome constitutes a significant and pressing public health challenge, affecting approximately 15% of individuals who are aged 65 and older, with another 45% of this demographic categorized as prefrail, indicating that they are on the brink of experiencing frailty.1 This condition, characterized by a notable reduction in physiological resilience and increased vulnerability to stressors, becomes increasingly prevalent as age advances. Further, this worrisome trend is especially pronounced among women, various racial and ethnic minorities, individuals facing diverse financial hardships, and those living in environments specifically designed to offer support. The decline in strength, endurance, and overall physiological function makes everyday activities, such as climbing stairs, lifting objects, and walking, challenging. This loss of physical reserves increases vulnerability to various stressors, including infections, medication changes, falls, and environmental shifts, which can lead to serious health consequences like cognitive decline, a higher risk of falls, hospitalization, loss of independence, and even death.

The rapidly aging population and the increasing incidence of frailty necessitate urgent focus and decisive action. Prioritizing and executing effective rehabilitative services in conjunction with community support initiatives is crucial to addressing the diverse needs of these individuals. By incorporating AI-driven interventions into rehabilitation frameworks, we can enhance care strategies and offer tailored solutions for the recovery and ongoing management of frail older adults. Such technologies empower therapists to employ a holistic approach to tackling frailty, ultimately elevating the quality of life for individuals while alleviating the burdens on health care providers and systems.

Therapy Benefits and Challenges
Frailty should not be misconstrued as an unavoidable aspect of the aging process; instead, it is frequently amenable to intervention and management. Exercise regimens stand out as effective modalities for enhancing mobility and mitigating the risk of falls among frail older adults, especially in community settings or aged care facilities where challenges related to mobility and cognitive function are heightened. Rehabilitation therapies are crucial in preventing functional decline and promoting independence, addressing the complex nature of frailty that includes physical, mental, cognitive, and social aspects. Targeted interventions aimed at frailty have demonstrated efficacy, including resistance training, comprehensive multimodal programs, and multicomponent exercise initiatives that integrate balance, aerobic, and muscle-strengthening activities.

While traditional rehabilitative approaches yield benefits, practitioners face a myriad of challenges—such as accurately identifying frailty, scaling treatment modalities, personalizing care plans, and ensuring ongoing patient monitoring—that complicate the therapeutic landscape. The advent of innovations in AI and other technological advancements heralds a transformative potential for rehabilitative services, augmenting therapists’ capabilities to devise effective strategies for addressing frailty in their patients.

AI
AI is poised to revolutionize health care delivery in a multitude of diverse environments and settings by leveraging advanced algorithms and highly sophisticated machine learning techniques meticulously tailored to enhance patient outcomes and streamline operational efficiencies. This innovative technology is not just a passing trend; it represents a groundbreaking shift in how medical services are provided and managed across various platforms, from hospitals to remote clinics, ultimately aiming to improve accessibility and efficacy in patient care.

Rehabilitative therapy services stand to gain significantly from the integration of AI, ushering in a transformative era of rehabilitation that (1) facilitates the early identification of frailty risk, surpassing the limitations of traditional clinical assessment methods, (2) promotes the administration of highly personalized therapies that not only elevate patient engagement and motivation but also lead to markedly improved outcomes, and (3) enhances the seamless incorporation of innovative, AI-driven rehabilitation tools—ranging from virtual-reality fitness applications to robotic assistive devices and beyond.

Frailty Assessment
The early and precise recognition of frailty in individuals is crucial for facilitating timely interventions, appropriate treatments, and effective prevention strategies aimed at enhancing the management of care and improving outcomes of those affected. According to the Fried Frailty Phenotype, frailty is characterized by unintentional weight loss (10 lbs in the past year), self-reported exhaustion, low physical activity, slow walking speed, and weakness (grip strength).2

The complexities surrounding the early identification of frailty are multifaceted, primarily stemming from the absence of a universally accepted measurement approach. Recent systematic reviews have illuminated a staggering array of at least 60 distinct tools designed for frailty identification, among which a mere nine have achieved regular application in clinical practice.3 Furthermore, the determination of frailty status frequently relies on manual assessments, which are not only labor-intensive but also necessitate a significant degree of clinical expertise and remain inherently subjective in nature. The implications of this variability are profound, as they underscore the challenges faced by health care professionals in achieving accurate and timely frailty assessments.

Challenges in frailty assessment, along with the need to predict which patients may become frail over time, known as “predictive frailty,” have spurred significant advances in AI, which is essential for forecasting health outcomes and risks. AI-driven tools can analyze EHRs, patient demographics, and clinical data to generate frailty scores. These scores can help clinicians make informed decisions about interventions, resource allocation, and care management for individuals with frailty.

The recent development of an AI-driven frailty assessment tool by the dedicated team at Mass General Brigham demonstrates the power of AI in the evaluation of frailty.4 This innovative tool leverages readily available data extracted from EHRs, encompassing crucial demographic factors such as age, sex, and race alongside comprehensive details regarding comorbidities, medication regimens, functional capabilities, and laboratory findings. By applying advanced machine learning algorithms to a large patient dataset, the tool provides real-time frailty assessments during clinical consultations, enabling clinicians to make informed care decisions. The AI model has demonstrated over 85% accuracy in predicting postoperative complications among surgical patients, allowing for personalized preoperative interventions like physical therapy and nutritional support. The outcomes attributable to this tool are noteworthy, highlighting shorter hospital stays for frail patients, lower rates of postoperative complications, improved patient satisfaction metrics, and enhanced collaboration among health care providers. The implications for clinical practice are profound, as this tool not only streamlines the assessment process but also fosters a more proactive and tailored approach to managing frailty within diverse patient populations and health care settings.

Virtual Reality
Virtual reality (VR) presents an innovative frontier in rehabilitative therapy, offering immersive and interactive experiences meticulously designed to meet the unique needs of individual patients. VR’s ability to recreate diverse physical scenarios empowers patients, particularly those grappling with frailty, to participate in safe and controlled exercises that foster recovery in both strength and balance. This engaging methodology not only amplifies patient motivation but also equips therapists with the capability to personalize interventions informed by real-time data reflecting patient progress, thereby reinforcing VR’s potential as a transformative tool in frailty rehabilitation. Moreover, VR’s proficiency in simulating authentic environments and tasks facilitates patient engagement in therapeutic exercises that are not only relevant but also adaptable, thereby mitigating the tedium often associated with conventional rehabilitation practices.

This shift can lead to enhanced adherence and improved therapeutic outcomes for those facing the challenges of frailty. The increased engagement fostered by VR can translate into more consistent attendance in therapy sessions, an essential component for the recovery journey of frail individuals. Furthermore, the technology allows for environments that are both customizable and flexible, catering specifically to the distinct requirements and evolving progress of each patient, thus promoting a rehabilitative experience that is both personalized and safe.

Smart Devices
Rehabilitation achieves its fullest potential when exercises are executed with precision and commitment, both within clinical settings and in the comfort of one’s home. The advent of AI-driven smart devices, embedded with sensors to monitor movements, posture, and muscle engagement, serves to foster greater adherence, mitigate the risk of injuries during unsupervised sessions, and empower patients to assume an active role in their recovery journey. Wearable technology plays a pivotal role in enabling individuals to track their health metrics and exercise routines, particularly for those engaged in physical therapy or grappling with conditions such as stroke, Parkinson’s disease, or general frailty. For these populations, diligent monitoring of daily activity levels is paramount to upholding posttreatment protocols and averting the recurrence of injuries or falls.

Wearable sensors provide a continuous stream of data throughout exercise regimens, equipping therapists and researchers with vital information to assess progress, identify areas requiring improvement, and formulate tailored recommendations that adjust exercise intensity or modify treatment strategies accordingly. Thus, the integration of such technology not only enriches the rehabilitation experience but also reinforces the collaborative effort between patient and provider in the pursuit of optimal recovery outcomes.

Robotic physical therapy, also known as robotic rehabilitation, integrates advanced robotic devices into recovery processes. These machines are designed to aid motor function recovery through repetitive, controlled movements that enhance therapeutic exercises. The use of robotics represents a shift in rehabilitation, combining technology with clinical expertise. Such innovations can enhance traditional therapies and enable customized patient care, thereby reducing the physical burden on therapists while allowing them to prioritize comprehensive patient support and care. Robotic devices encompass a variety of advanced systems, such as exoskeletons that assist with movement, end-effector robots designed to manipulate limbs or hold objects, facilitation of targeted exercises for specific muscle groups, gait training systems aimed at improving walking abilities, as well as robots focused on the rehabilitation of both upper and lower extremities for enhanced recovery.

Telerehabilitation
Telehealth represents a transformative shift in the landscape of health care, particularly within the realm of rehabilitation (telerehabilitation). This integration of digital technologies—encompassing computers, mobile devices, and various online platforms—facilitates enhanced access and quality of care through remote health care services and management. Patients are now able to engage with health care providers via phone consultations, video conferencing, and dedicated applications. The ability to monitor patients from afar yields a multitude of benefits, including increased patient convenience, significant time savings, decreased hospital admissions, expedited discharge processes, augmented therapy intensity, improved adherence to treatment regimens, and more effective oversight of health conditions alongside treatment-related side effects.5 Moreover, telehealth fosters enhanced communication between patients and health care professionals, bridging gaps that have long hindered effective care. In regions where rehabilitation services remain scarce, the significance of telehealth cannot be overstated.

Additional Considerations
As the landscape of rehabilitation evolves, the confluence of AI with therapeutic practices not only redefines patient care but also necessitates a paradigm shift in the way practitioners approach treatment. This integration requires a comprehensive understanding of both the technological capabilities and the nuanced needs of patients, thereby fostering an environment where individualized care is paramount. The potential for enhanced outcomes through tailored interventions is immense. Yet, it is equally vital to ensure that these advancements do not exacerbate existing challenges within the health care system.

— Mark D. Coggins, PharmD, BCGP, FASCP, is a long term care expert and corporate pharmacy consultant for Touchstone Communities, a leading provider of senior care that includes skilled nursing care, memory care, and rehabilitation for older adults throughout Texas. He’s a past director of the American Society of Consultant Pharmacists and was nationally recognized by the Commission for Certification in Geriatric Pharmacy with the Excellence in Geriatric Pharmacy Practice Award.

References
1. Bandeen-Roche K, Seplaki CL, Huang J, et al. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70(11):1427-1434.

2. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.

3. Ludlow K, Todd O, Reid N, et al. Frailty in primary care: challenges, innovations, and future directions. BMC Prim Care. 2023;24(1):129.

4. AI-driven frailty assessment tool yields results at Mass General Brigham. Health Industry Trends website. https://healthindustrytrends.com/ai-driven-frailty-assessment-tool-yields-results-at-mass-general-brigham/. Published March 6, 2025.

5. Dawson R, Oliveira JS, Kwok WS, et al. Exercise interventions delivered through telehealth to improve physical functioning for older adults with frailty, cognitive, or mobility disability: a systematic review and meta-analysis. Telemed J E Health. 2024;30(4):940-950.