Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial

Ekdahl, Anne; Wiréhn, Ann-Britt; Alwin, Jenny; Jaarsma, Tiny; Unosson, Mitra; Husberg, Magnus; Eckerblad, Jeanette; Milberg, Anna; Krevers, Barbro; Carlsson, Per

doi:10.1016/j.jamda.2015.01.074

Cited by 48 publications

(84 citation statements)

References 35 publications

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“…The main outcomes from the AGe-FIT study showed that interdisciplinary care at an AGU, based on CGA, reduced days in hospital and increased the participants' sense of security in care interaction without increasing costs (Ekdahl et al 2015). It did not reduce symptom prevalence or symptom burden.…”

Section: Msas Subscale Scoresmentioning

confidence: 95%

“…Assessment -a Frailty Intervention (AGe-FIT) (Ekdahl et al 2015). The study hypothesis of the Age-FIT was that the care based on CGA provided by an ambulatory geriatric outpatient clinic would reduce hospitalization (primary outcome) compared with usual care.…”

Section: Symptom Management Modelmentioning

confidence: 99%

“…costs (Ekdahl et al 2015). Secondary data regarding symptoms from this AGe-FIT study are included and presented in this thesis in papers II and IV.…”

Section: Symptom Management Modelmentioning

confidence: 99%

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Symptom burden among people with chronic disease

Eckerblad¹

2015

Linköping University Medical Dissertations

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Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief. Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease. Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT. Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III). Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider

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Section: Msas Subscale Scoresmentioning

confidence: 95%

Section: Symptom Management Modelmentioning

confidence: 99%

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Symptom burden among people with chronic disease

Eckerblad¹

2015

Linköping University Medical Dissertations

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“…2 Of note, in the results section of our review, we described the reduction in length of stay correctly. We have corrected Table 4 for inclusion as an erratum and include several edits for improved clarity.…”

Section: R Ekdahl Correctly Points Out That Inmentioning

confidence: 98%

Regarding “Effectiveness of Intensive Primary Care Interventions: A Systematic Review”

2018

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hospitalizations (mean of 2.1 vs. 2.4 over 24 months, p = 0.212) and a reduction in average length of stay (mean of 11.1 days vs. 15.2 days over 24 months, p = 0.035).2 Of note, in the results section of our review, we described the reduction in length of stay correctly. We have corrected Table 4 for inclusion as an erratum and include several edits for improved clarity. We apologize for the error. Overall, this error does not affect the conclusions of our systematic review.In Table 2 of our review, we reported the sample size for each included study. For randomized controlled trials, we typically reported the number of patients originally randomized, after exclusion criteria were applied. In the case of Dr. Ekdahl's 2015 study, the number of patients reported as originally randomized was 844, but exclusion criteria were applied after randomization. Of these 844 patients, 55% were excluded, with more patients excluded from the treatment group than the control group. Given the high level of post-randomization exclusion and our lack of clarity about the enrollment process, we were not certain that the 382 patients reported as enrolled in the abstract represented a number comparable to other randomized controlled trials in our review.

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“…The Geriatric Department at the hospital had a memory clinic and an orthogeriatric ward. The study protocol and results on the primary outcome (number of hospitalizations), other health-related outcomes and cost effectiveness have previously been published [14][15][16][17].…”

Section: Study Design and Settingmentioning

confidence: 99%

Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization

Mazya

Garvin²,

Ekdahl

2018

Aging Clin Exp Res

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Background Multimorbidity and frailty are often associated and Comprehensive Geriatric Assessment (CGA) is considered the gold standard of care for these patients. Aims This study aimed to evaluate the effect of outpatient Comprehensive Geriatric Assessment (CGA) on frailty in community-dwelling older people with multimorbidity and high health care utilization. Methods The Ambulatory Geriatric Assessment-Frailty Intervention Trial (AGe-FIT) was a randomized controlled trial (intervention group, n = 208, control group n = 174) with a follow-up period of 24 months. Frailty was a secondary outcome. Inclusion criteria were: age ≥ 75 years, ≥ 3 current diagnoses per ICD-10, and ≥ 3 inpatient admissions during 12 months prior to study inclusion. The intervention group received CGA-based care and tailored interventions by a multidisciplinary team in an Ambulatory Geriatric Unit, in addition to usual care. The control group received usual care. Frailty was measured with the Cardiovascular Health Study (CHS) criteria. At 24 months, frail and deceased participants were combined in the analysis. Results Ninety percent of the population were frail or pre-frail at baseline. After 24 months, there was a significant smaller proportion of frail and deceased (p = 0.002) and a significant higher proportion of pre-frail patients in the intervention group (p = 0.004). Mortality was high, 18% in the intervention group and 26% in the control group. Conclusion Outpatient CGA may delay the progression of frailty and may contribute to the improvement of frail patients in older persons with multimorbidity.

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Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial

Abstract: clinicaltrials.gov identifier: NCT01446757.

Cited by 48 publications

References 35 publications

Symptom burden among people with chronic disease

Symptom burden among people with chronic disease

Regarding “Effectiveness of Intensive Primary Care Interventions: A Systematic Review”

Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization

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