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

Kempen, Janneke A. L. van; Schers, Henk; Jacobs, Anne; Zuidema, Sytse U.; Ruikes, Franca G H; Robben, Sarah H M; Melis, René J. F.; Rikkert, Marcel G M Olde

doi:10.3399/bjgp13x664289

Cited by 58 publications

(62 citation statements)

References 34 publications

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“…This prospective study was a preplanned part of the Validation Study of the Two-step Older persons Screening study (TOS study), in which six general practitioners’ practices organised frailty screening for all their patients aged 70 years and over 23. Detailed information about the rational and design of the TOS study, and the subsequent recruitment of the participants for the Senior Step Study were described previously 22…”

Section: Methodsmentioning

confidence: 99%

Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons

Bongers¹,

Schoon²,

Rikkert³

2016

BMJ Open

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ObjectivesSelf-management of mobility and fall risk can be important in fall prevention; however, it remains unstudied. Therefore, the current study assessed whether community-dwelling older persons were able to repeatedly self-assess maximum step length (MSL) and gait speed (GS) in their own home for a 6-month period, how these tests changed during this period and if these changes were related to falling.DesignThis is a prospective study.SettingThis study was conducted at home.ParticipantsA total of 56 community-dwelling older adults (24 women (43%), mean age 76.2 (SD 3.9) years) entered the study; of which, 45 completed the study.MethodsParticipants performed MSL and GS once a week in their own home during a 6-month period.Primary and secondary outcomesRepeated MSL and GS measurements were the primary outcomes. Falls, self-management and mobility were the secondary outcomes.ResultsSelf-assessment of MSL and GS by older persons is feasible. Compliance of repeatedly self-measuring MSL and GS was good; the median number of weekly measurements was 23.0 (88%) and 21.0 (81%) for MSL and GS, respectively. Drop-outs showed less self-management abilities compared to the participants who completed the study (p=0.049). Linear mixed models showed a small significant improvement in MSL and GS over time (p<0.001), without an influence on falling.ConclusionsMost community-dwelling older persons are able and willing to repeatedly assess their MSL and GS. Self-managing mobility and fall risk did not increase fall occurrence. The fact that older persons can be actively involved in their own healthcare is clinically relevant. Further studies are needed to examine the (cost-)effectiveness of self-management in fall prevention interventions.

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Section: Methodsmentioning

confidence: 99%

Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons

Bongers¹,

Schoon²,

Rikkert³

2016

BMJ Open

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“…21 The EASY-Care TOS has shown good construct validity and interrater reliability, and is well accepted by primary care professionals. 22,23 All practices were instructed to include 50 frail elders aged Ն70 years.…”

Section: Recruitmentmentioning

confidence: 99%

“…After the Easy-Care TOS assessment, the GP and practice nurse/research assistant made a final decision on the presence of frailty, based on clinical reasoning using all explicit and tacit information. 21 In addi-tion, the complexity of the care context, representing the organization and coordination of care, was judged. 24 Frail elders with and without complex care were included.…”

Section: Recruitmentmentioning

confidence: 99%

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Ruikes

Zuidema

Akkermans

et al. 2016

The Journal of the American Board of Family Medicine

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Background:The increasing number of community-dwelling frail elderly people poses a challenge to general practice. We evaluated the effectiveness of a general practitioner-led extensive, multicomponent program integrating cure, care, and welfare for the prevention of functional decline.Methods: We performed a cluster controlled trial in 12 general practices in Nijmegen, the Netherlands. Community-dwelling frail elderly people aged >70 years were identified with the EASY-Care twostep older persons screening instrument. In 6 general practices, 287 frail elderly received care according to the CareWell primary care program. This consisted of proactive care planning, case management, medication reviews, and multidisciplinary team meetings with a general practitioner, practice and/or community nurse, elderly care physician, and social worker. In another 6 general practices, 249 participants received care as usual. The primary outcome was independence in functioning during (instrumental) activities of daily living (Katz-15 index). Secondary outcomes were quality of life [EuroQol (EQ5D؉C) instrument], mental health and health-related social functioning (36-item RAND Short

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“…EASY-Care Two-step Older persons Screening (EASY-Care-TOS 13 ; Online Appendix Figure 1) is a 2-step method developed for use in primary care. In the first step, the FP uses already available information, including clinical intuition and knowledge from the patient record, to complete a 14-item checklist (see Online Appendix Document 1).…”

Section: Comprehensive Geriatric Assessment By An Fpmentioning

confidence: 99%

“…8,11 Therefore, more efficient CGA tools are necessary for family practice, for which we developed a stepwise approach in which a short tool is used as a first step to select the patients who will really benefit from CGA. 1,8,12,13 In general, CGA by a hospital geriatrician is used as the standard for validating new primary care frailty instruments. CGA is a valid instrument for the management of frail elderly in hospital care 14 ; however, applying tools for CGA in other than the traditional hospital setting, probably means that their use, meaning, effectiveness, and output differ.…”

mentioning

confidence: 99%

Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians

Kempen

Melis

Perry

et al. 2015

The Journal of the American Board of Family Medicine

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Background: To compare the outcomes of Comprehensive Geriatric Assessments by family physicians and geriatricians.Methods: An explorative observational study was conducted in six family practices (12 ambulatory family practitioners) and 1 geriatric department (4 hospital-based geriatricians) from a university medical center in Nijmegen (the Netherlands). As participants, we included 587 patients aged 70 years and older and registered in the six family practices. The main outcome measures were the judgment on the following: 1) absence or presence of frailty and 2) the state (good-fair-poor) on 8 underlying domains (physical, medication, cognition, sensory, instrumental activities of daily living scale, mobility, mental, and social) according to family physicians and geriatricians based on a Comprehensive Geriatric Assessment.Results: Family physicians and geriatricians agreed on frailty absence/presence in 76% of cases. Geriatricians considered elderly more often frail than family physicians did (n ‫؍‬ 294, 50% vs n ‫؍‬ 213, 36%). Disagreement on frailty status was notably found in the patients who had less distinct, either poor or good, health states. Discordant frailty judgments, in which the geriatrician rated a person as frail and the family physicians did not, were related to geriatricians more often rating physical health as impaired. Further, geriatricians' judgments of frailty were more strongly related to impaired scores on the domains cognition, sensory, mobility, and mental compared with family physicians judgments: odds ratios 79.3 versus 9.3, 7.6 versus 2.0, 25.0 versus 3.0, and 18.0 versus 2.2, respectively. Impaired physical health and problematic medication use had equally strong associations with frailty in geriatricians and family physicians: odds ratios of 11.5 versus 10.4 and 2.4 versus 2.5, respectively.Conclusions: Geriatricians more often judge patients as frail compared with family physicians and seem to evaluate the available information differently. With increasing collaboration between primary and secondary care, understanding these differences becomes increasingly relevant. (J Am Board Fam Med 2015;28:240 -248.)

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

Cited by 58 publications

References 34 publications

Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons

Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Diagnosis of Frailty after a Comprehensive Geriatric Assessment: Differences between Family Physicians and Geriatricians

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