FrailtyNCT07490847
Telehealth-Supported Discharge Programme for Frail Older Adults
A study testing Telehealth discharge support programme in people with Frailty, run by Chinese University of Hong Kong at 1 site in Hong Kong.
Trial summary
This pilot clinical trial aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a telehealth-supported discharge programme on physical and mental health outcomes, and healthcare utilization among community-dwelling older adults with frailty after hospital discharge. The objectives are: 1. Read more about this study
- Who is it for?
- Ages 65 years and older
- Conditions the study is for
- Frailty
- What is being tested?
- Telehealth discharge support programme
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 1 siteHong Kong
- Study dates
- 1 Apr 2026to 31 Mar 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 65 years and older
- All sexes
- No healthy volunteers
- Older adult
Who may be able to join
- Aged 65 years or older;
- Able to speak Cantonese;
- Meet the operational definition of frailty, which is defined as an individual who scores 3 or more on the 5-item FRAIL scale, which reflects fatigue, resistance, ambulation, illnesses, and weight loss;
- Are mentally competent according to the Abbreviated Mental Test (AMT ≥ 6);
- Discharged from an acute hospital within the last two weeks and residing at home; and
- Have access to a digital device with internet connectivity, such as a smartphone, tablet, or computer
Who cannot join
- Currently undergoing active psychiatric treatment for severe mental illness (e.g., schizophrenia, bipolar disorder) that result in serious functional impairment
- Experiencing medical conditions that contraindicate physical exercise (e.g., recent acute myocardial infarction, unstable cardiovascular pathology, fracture within the past month); and/or
- Presenting with any significant visual, language, or communication impairments that would impede their ability to meaningfully engage with the programme
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Hong Kong1 site
The Chinese University of Hong Kong
Shatin, New Territories
Sarah Xiao, +852 3943 1502, sarahxiao@cuhk.edu.hk
About this study
Official title: Telehealth-Supported Discharge Programme on Health Outcomes Among Frail Older Adults: A Pilot Randomized Controlled Trial
This pilot clinical trial aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a telehealth-supported discharge programme on physical and mental health outcomes, and healthcare utilization among community-dwelling older adults with frailty after hospital discharge.
The objectives are:
Read more
- To determine the feasibility and acceptability of the programme by assessing participant recruitment, retention, adherence rates, and satisfaction;
- To evaluate the preliminary effects of the programme on a) physical health outcomes (e.g., physical fitness, activities of daily living), b) mental health outcomes (e.g., depressive symptoms, perceived social support, quality of life, subjective well-being), and c) healthcare utilization (e.g., emergency department visits, hospital readmissions); and
- To identify perceived barriers and facilitators of the programme and evaluate the acceptability and usability of gerontechnology activity sensors and pedometers for monitoring activity levels.
Community-dwelling older adults 65 years with frailty (N=50) will be recruited through a local hospital. Participants will be randomized to either the intervention or control group. The 12-week telehealth discharge support programme consists of weekly reablement-focused sessions integrating gerontechnology activity sensors and pedometers to enhance physical and mental health outcomes. Both groups will continue to receive usual care.
Descriptive statistics will be used to summarize participant data. Effect sizes will be calculated to estimate the effects of the intervention on the outcomes. Qualitative data will be analyzed using thematic analysis.
Read the detailed description
Frailty is one of the most common geriatric syndromes among older adults, and manifests as three or more of these symptoms: weight loss, fatigue, weakness, slow walking speed (<1.0m/s), and low physical activity. Characterized by multisystem physiological decline, frail older adults are at an increased risk for illnesses and poor psychosocial well-being.
Older adults with frailty are also more susceptible to hospitalization and adverse outcomes following discharge. Known as the "critical period" after hospital discharge, these individuals are at risk for unplanned emergency department visits and hospital readmissions. Further, frail older adults often experience prolonged recovery periods following hospital discharge, and may also be more sedentary, which can lead to further functional decline.
Existing evidence emphasize the need for tailored interventions to support frail older adults and address their complex, multifaceted physical and mental health needs during their transition from hospital to home. This pilot study addresses gaps in the literature by introducing a structured telehealth discharge support programme tailored to community-dwelling older adults with frailty to improve physical and mental health outcomes, reduce healthcare utilization, and enhance self-management and functional recovery. To facilitate innovation in transitional care, the programme incorporates remote health monitoring tools such as home-based gerontechnology (e.g., activity sensors) and pedometers to support physical activity and recovery.
- Conditions
- Frailty
- Being tested
- Telehealth discharge support programme
- Keywords
- Frailty, Hospital Discharge, Older Adults, Psychoeducation, Reablement, Randomized Controlled Trial
- Medical subject headings
- Frailty
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Telehealth discharge support programmeBehavioural
The 12-week telehealth-supported discharge programme consists of weekly one hour virtual sessions consisting of didactic and experiential activities to support recovery after hospital discharge. Sessions focus on improving physical activity and mobility through home-based exercises, strengthening self-management skills related to frailty, promoting mental resilience and well-being, and providing opportunities for peer interaction and social support.
Additionally, one activity sensor will be installed in the homes of participants within the intervention group to monitor and evaluate their physical activity levels and patterns over time. The advanced smart home activity sensors, equipped with AI capabilities, will enable remote monitoring of daily activity patterns among participants. A pedometer will also be provided to participants as a motivational tool to reduce sedentary behaviour.
| Study group | Role | What they receive |
|---|---|---|
| Telehealth discharge support programme | Experimental | Not described Receives: Behavioral: Telehealth discharge support programme |
| Usual care | No intervention | Participants assigned to the control group will continue to receive usual care. Usual care typically includes home visits and/or follow-up calls by community nurses focused on medication management and basic health education, as needed. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Physical fitness
Physical fitness will be assessed using the Senior Fitness Test (SFT), which is comprised of seven tests that evaluate body strength, flexibility, agility, aerobic capacity, and body composition. The tests include the following: 30-second chair stand, 30-second arm curl, 2-minute step test, chair sit-and-reach, back scratch, 8-foot-up-and-go, and 2-minute step-in-place test. Each component is scored separately using standardized units (e.g., number of repetitions, distance, or time), with higher scores generally indicating better physical fitness, except for timed tests (e.g., 8-foot up-and-go), where lower times indicate better performance.
Measured: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Secondary outcomes (6)
Activities of daily living
Functional independence will be evaluated using the Katz Index of Independence in Activities of Daily Living (ADL). The Katz Index of Independence in ADL is a 6-item tool that assesses basic self-care abilities, such as feeding, bathing, dressing, transferring, toileting, and mobility. Total scores range from 0 to 6, with higher scores indicating greater independence in self-care activities.
Measured: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Instrumental activities of daily living
Functional independence will also be evaluated using the Lawton Instrumental Activities of Daily Living (IADL) Scale. The Lawton IADL Scale consists of 8 items that evaluate complex activities for independent living, such as preparing meals, handling finances, using transportation, housekeeping, doing laundry, shopping, using the telephone, and taking medications. Total scores range from 0 to 8, with higher scores indicating greater independence in instrumental activities.
Measured: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Depressive symptoms
Depressive symptoms will be measured by the 4-item Geriatric Depression Scale (GDS-4). The GDS-4 consists of four dichotomous (yes/no) items, with total scores ranging from 0 to 4. Higher scores indicate greater depressive symptoms.
Measured: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Perceived social support
Social support will be assessed using the 10-item Duke Social Support Index (DSSI), which evaluates constructs such as social satisfaction and social interaction. Total scores range from 0 to 30, with higher scores reflecting greater perceived levels of social support.
Measured: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Health-related quality of life
Health-related quality of life (QoL) will be assessed using the EuroQol 5 Dimension 5-Level (EQ-5D-5L) questionnaire. The instrument aims to evaluate the following five QoL dimensions: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. Each dimension is rated on five levels, which include no problems (1), slight problems (2), moderate problems (3), severe problems (4), and extreme problems/unable to perform (5). Responses can be calculated into a single index score, typically ranging from less than 0 (worse than death) to 1 (full health), with higher scores indicating better health-related QoL.
Measured: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Subjective well-being
Subjective well-being will be measured using the 5-item WHO Well-being Index, which assesses mental well-being over the past two weeks. The scale is comprised of five positively worded items rated on a 6-point Likert scale, yielding a total score ranging from 0 to 25. Higher scores indicate greater subjective well-being, with a cutoff below 13 suggesting poor well-being.
Measured: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Mar 2026
- Study start1 Apr 2026 (estimated)
- Primary completion31 Mar 2027 (estimated)
- Study completion31 Mar 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for FrailtyStudies of the same condition, open and under way.
- More trials run by Chinese University of Hong KongThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 50 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Chinese University of Hong Kong
- Sponsor type
- University, hospital or other
- Collaborators
- United Christian Hospital
- Responsible party
- Principal investigator, Sarah Xiao, Chinese University of Hong Kong
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07490847
- Sponsor's protocol ID
- CIRB-2025-552-5
- Status last verified
- Mar 2026
- First submitted
- 6 Mar 2026
- Last updated
- 24 Mar 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 24 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Telehealth-Supported Discharge Programme on Health Outcomes Among Frail Older Adults: A Pilot Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07490847
- Acronym / sponsor ID
- CIRB-2025-552-5
- Conditions
- Frailty
- Keywords
- Frailty, Hospital Discharge, Older Adults, Psychoeducation, Reablement, Randomized Controlled Trial
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 50 participants (estimated)
- Lead sponsor
- Chinese University of Hong KongUniversity, hospital or other
- Collaborators
- United Christian Hospital
- Study start
- 1 Apr 2026 (estimated)
- Primary completion
- 31 Mar 2027 (estimated)
- Study completion
- 31 Mar 2027 (estimated)
- First posted
- 24 Mar 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This pilot clinical trial aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a telehealth-supported discharge programme on physical and mental health outcomes, and healthcare utilization among community-dwelling older adults with frailty after hospital discharge.
The objectives are:
- To determine the feasibility and acceptability of the programme by assessing participant recruitment, retention, adherence rates, and satisfaction;
- To evaluate the preliminary effects of the programme on a) physical health outcomes (e.g., physical fitness, activities of daily living), b) mental health outcomes (e.g., depressive symptoms, perceived social support, quality of life, subjective well-being), and c) healthcare utilization (e.g., emergency department visits, hospital readmissions); and
- To identify perceived barriers and facilitators of the programme and evaluate the acceptability and usability of gerontechnology activity sensors and pedometers for monitoring activity levels.
Community-dwelling older adults 65 years with frailty (N=50) will be recruited through a local hospital. Participants will be randomized to either the intervention or control group. The 12-week telehealth discharge support programme consists of weekly reablement-focused sessions integrating gerontechnology activity sensors and pedometers to enhance physical and mental health outcomes. Both groups will continue to receive usual care.
Descriptive statistics will be used to summarize participant data. Effect sizes will be calculated to estimate the effects of the intervention on the outcomes. Qualitative data will be analyzed using thematic analysis.
Detailed description
Frailty is one of the most common geriatric syndromes among older adults, and manifests as three or more of these symptoms: weight loss, fatigue, weakness, slow walking speed (<1.0m/s), and low physical activity. Characterized by multisystem physiological decline, frail older adults are at an increased risk for illnesses and poor psychosocial well-being.
Older adults with frailty are also more susceptible to hospitalization and adverse outcomes following discharge. Known as the "critical period" after hospital discharge, these individuals are at risk for unplanned emergency department visits and hospital readmissions. Further, frail older adults often experience prolonged recovery periods following hospital discharge, and may also be more sedentary, which can lead to further functional decline.
Existing evidence emphasize the need for tailored interventions to support frail older adults and address their complex, multifaceted physical and mental health needs during their transition from hospital to home. This pilot study addresses gaps in the literature by introducing a structured telehealth discharge support programme tailored to community-dwelling older adults with frailty to improve physical and mental health outcomes, reduce healthcare utilization, and enhance self-management and functional recovery. To facilitate innovation in transitional care, the programme incorporates remote health monitoring tools such as home-based gerontechnology (e.g., activity sensors) and pedometers to support physical activity and recovery.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Telehealth discharge support programme | Experimental | Behavioral: Telehealth discharge support programme |
| Usual care | No intervention | –Participants assigned to the control group will continue to receive usual care. Usual care typically includes home visits and/or follow-up calls by community nurses focused on medication management and basic health education, as needed. |
Who may qualify
- Ages
- 65 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Older adult
Key inclusion criteria (6 listed)
- Aged 65 years or older;
- Able to speak Cantonese;
- Meet the operational definition of frailty, which is defined as an individual who scores 3 or more on the 5-item FRAIL scale, which reflects fatigue, resistance, ambulation, illnesses, and weight loss;
- Are mentally competent according to the Abbreviated Mental Test (AMT ≥ 6);
- Discharged from an acute hospital within the last two weeks and residing at home; and
Key exclusion criteria (3 listed)
- Currently undergoing active psychiatric treatment for severe mental illness (e.g., schizophrenia, bipolar disorder) that result in serious functional impairment
- Experiencing medical conditions that contraindicate physical exercise (e.g., recent acute myocardial infarction, unstable cardiovascular pathology, fracture within the past month); and/or
- Presenting with any significant visual, language, or communication impairments that would impede their ability to meaningfully engage with the programme
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Telehealth discharge support programmeThe 12-week telehealth-supported discharge programme consists of weekly one hour virtual sessions consisting of didactic and experiential activities to support recovery after hospital discharge. Sessions focus on improving physical activity and mobility through home-based exercises, strengthening self-management skills related to frailty, promoting mental resilience and well-being, and providing opportunities for peer interaction and social support. Additionally, one activity sensor will be installed in the homes of participants within the intervention group to monitor and evaluate their physical activity levels and patterns over time. The advanced smart home activity sensors, equipped with AI capabilities, will enable remote monitoring of daily activity patterns among participants. A pedometer will also be provided to participants as a motivational tool to reduce sedentary behaviour. | Behavioural | Telehealth discharge support programme |
Primary outcome
Physical fitness
Time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Physical fitness will be assessed using the Senior Fitness Test (SFT), which is comprised of seven tests that evaluate body strength, flexibility, agility, aerobic capacity, and body composition. The tests include the following: 30-second chair stand, 30-second arm curl, 2-minute step test, chair sit-and-reach, back scratch, 8-foot-up-and-go, and 2-minute step-in-place test. Each component is scored separately using standardized units (e.g., number of repetitions, distance, or time), with higher scores generally indicating better physical fitness, except for timed tests (e.g., 8-foot up-and-go), where lower times indicate better performance.
6 secondary outcomes
Activities of daily living
Time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Instrumental activities of daily living
Time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Depressive symptoms
Time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Perceived social support
Time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Health-related quality of life
Time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Subjective well-being
Time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Mar 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Telehealth discharge support programme in people with Frailty, run by Chinese University of Hong Kong at 1 site in Hong Kong.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 24 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Hong Kong. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Sarah Xiao (+852 3943 1502, sarahxiao@cuhk.edu.hk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Physical fitness (time frame: Baseline (T0) and upon intervention completion at 12 weeks (T1)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Mar 2026.