A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty

Abstract

Background Integrated care may improve outcomes for older people living with frailty. We aimed to assess the effectiveness of a new, anticipatory, multidisciplinary care service in improving the wellbeing and quality of life (QoL) of older people living with severe frailty. Methods A community-based non-randomised controlled study. Participants (≥65 years, electronic Frailty Index ≥0.36) received either the new integrated care service plus usual care, or usual care alone. Data collection was at three time points: baseline, 2-4 weeks, and 10-14 weeks. The primary outcome was patient wellbeing (symptoms and other concerns) at 2-4 weeks, measured using the Integrated Palliative care Outcome Scale (IPOS); the secondary outcome was QoL, measured using EQ-5D-5L. To test duration of effect and safety, wellbeing and QoL were also measured at 10-14 weeks. Descriptive statistics were used to characterise and compare intervention and control groups (eligible but had not accessed the new service), with t-test, Chi-Square, or Mann-Whitney U tests (as appropriate) to test differences at each time point. Generalised linear modelling, with propensity score matching, was used for further group comparisons. Data were analysed using STATA v17. Results 199 intervention and 54 control participants were recruited. At baseline, intervention and control groups were similar in age, gender, ethnicity, living status, and body mass index, but not functional status or area deprivation score. At 2-4 weeks, wellbeing had improved in the intervention group but worsened in the control (median IPOS -5 versus 2, p<0.001). QoL improved in the intervention group but was unchanged in the control (median EQ-5D-5L 0.12, versus 0.00, p<0.001). After adjusting for age, gender, and living status, the intervention group had an average total IPOS score reduction at 2-4 weeks of 6.34 (95% CI: -9.01: -4.26, p<0.05); this improvement was sustained, with an average total IPOS score reduction at 10-14 weeks of 6.36 (95% CI: -8.91:-3.80, p<0.05). After propensity score matching based on functional status/area deprivation, modelling showed similar results, with a reduction in IPOS score at 2-4 weeks in the intervention group of 7.88 (95% CI: -12.80: -2.96, p<0.001). Conclusions Our findings suggest that the new, anticipatory, multidisciplinary care service may have improved the overall wellbeing and quality of life of older people living with frailty at 2-4 weeks and the improvement in wellbeing was sustained at three months. Ethics approval NHS Research Ethics Committee 18/YH/0470 and IRAS-250981. Trial registration The trial was retrospectively registered at the International Standard Randomised Controlled Trial Number (ISRCTN) registry (registration date: 01/08/2022, registration number: ISRCTN10613839).

Experiences of a Novel Integrated Service for Older Adults at Risk of Frailty: A Qualitative Study

“…This study is part of a larger nonrandomized trial of the service, with evaluation of symptoms and quality-of-life at baseline, 2 to 4 weeks, and 10 to 14 weeks. 12 In addition to this trial, an experience survey was conducted, with in-depth interviews with a sample of survey respondents. This paper reports the free-text survey responses and interview findings.…”

“…This study was conducted within a novel integrated care service located in Hull, England, UK. This new integrated care service is described in full elsewhere, 12 but included a comprehensive assessment and care plan provided by a specialized multidisciplinary team, with a free lunch during a 3 to 5 h single appointment.…”

“… 11 A recent study showed that the novel integrated care service improves the well-being and quality of life of older people with frailty within 2 to 4 weeks and sustains the improvement for up to 3 months. 12 There is limited evidence on the valued components of integrated care for older individuals living with frailty and how it should be structured, as well as limited knowledge of their experiences with integrated services.…”

Diagnostic Methods of Frailty Syndrome Used in 2018-2023: Scoping Review Pubmed

“…The conducted research has shown that FRED games are an effective technical solution to reduce the risk of vulnerability [23]. In some studies, several scales and questionnaires were used for diagnosis [24][25][26][27][28][29][30].…”