Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people

Abstract

BackgroundFrail elderly people need an integrated and coordinated care. The two-armed study "Continuum of care for frail elderly people" is a multi-professional and multidimensional intervention for frail community-dwelling elderly people. It was designed to evaluate whether the intervention programme for frail elderly people can reduce the number of visits to hospital, increase satisfaction with health and social care and maintain functional abilities. The implementation process is explored and analysed along with the intervention. In this paper we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants.Methods/designThe study is a randomised two-armed controlled trial with follow ups at 3, 6 and 12 months. The study group includes elderly people who sought care at the emergency ward and discharged to their own homes in the community. Inclusion criteria were 80 years and older or 65 to 79 years with at least one chronic disease and dependent in at least one activity of daily living. Exclusion criteria were acute severely illness with an immediate need of the assessment and treatment by a physician, severe cognitive impairment and palliative care. The intention was that the study group should comprise a representative sample of frail elderly people at a high risk of future health care consumption. The intervention includes an early geriatric assessment, early family support, a case manager in the community with a multi-professional team and the involvement of the elderly people and their relatives in the planning process.DiscussionThe design of the study, the randomisation procedure and the protocol meetings were intended to ensure the quality of the study. The implementation of the intervention programme is followed and analysed throughout the whole study, which enables us to generate knowledge on the process of implementing complex interventions. The intervention contributes to early recognition of both the elderly peoples' needs of information, care and rehabilitation and of informal caregivers' need of support and information. This study is expected to show positive effects on frail elderly peoples' health care consumption, functional abilities and satisfaction with health and social care.Trial registrationClinicalTrials.gov: NCT01260493

Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

“…The study included patients, aged ≥75 years, being in need of in-hospital treatment and who fulfilled the foundation of frailty according to the recently validated FRESH (FRail Elderly Support research group) screening instrument,12,20,21 ie, two or more of the following criteria: tiredness from a short walk, general fatigue, frequent falls/anticipation of falls, dependence in shopping and three or more visits to the emergency ward during the last 12 months. Patients were excluded if they declined participation in the study, were unable to give informed consent (and it was impossible to obtain informed consent from a relative), were previously defined MÄVA patients (when a patient already had a MÄVA file implying direct access to the MÄVA facilities), or were clearly suited for care at a conventional acute medical care unit due to the severity of his/her acute condition (acute myocardial infarction, acute stroke, sepsis, or other acute life-threatening conditions).…”

Implementing a continuum of care model for older people - results from a Swedish case study

“…The development of the model is based on experiences from practitioners and managers in the care providing organisation, and research findings from intervention studies targeting frail older people [3]. A geriatric assessment is performed at the emergency ward of the hospital, by registered nurses with geriatric competence.…”

Development of an instrument for the identification of frail older people as a target population for integrated care

“…They proposed geriatric screening and multidimensional assessment as a way to enhance integration. 3 De Lepeleire et al stated that frailty provides a conceptual basis for a health-based integrative approach. 19 With the development of the Easycare-TOS, the present researchers wanted to provide a good starting point for providing integrated care.…”

“…3,4 Care should change from being reactive and disease oriented to proactive and patient oriented; this is often called integrated care. 5,6 First, though, the older people who would benefit from integrated care, that is those who are frail, must be identified.…”