Integrated primary and geriatric care for frail older adults in the community: Implementation of a complex intervention into real life

Inzitari, Marco; Pérez, Laura Mónica; Enfedaque, María Belén; Soto, Luis Díaz; Díaz, Francisco Javier Rodríguez; Gual, Neus; Martin, Élisabeth; Orfila, Francesc; Mulero, Paola; Ruíz, Rafael; Cesari, Matteo

doi:10.1016/j.ejim.2018.07.022

Cited by 34 publications

(41 citation statements)

References 26 publications

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“…Frailty represents a critical moment in older adults, leading to a progressive decrease in global capacity. In fact, to prevent disability during aging is essential to recognize and manage frailty in the community [107,108].…”

Section: Delirium Prevention By Targeting Frailty With Physical Exercisementioning

confidence: 99%

The role of physical exercise and rehabilitation in delirium

et al. 2020

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Key summary pointsAim Analyze the intersections between delirium, physical exercise and rehabilitation, to better understand their interrelation and to visualize future lines of research. Findings Delirium and physical function are closely related, since physical dysfunction is described as a risk factor and as a symptom of delirium, and there are also short-and long-term functional consequences related to delirium. Furthermore, physical therapy strategies included in multicomponent interventions to prevent delirium, have shown to be effective in managing delirium. Another important risk factor for delirium is frailty, that given its condition of being reversible basically through rehabilitation programs, begins to play an important role in the prevention and management of delirium, although more studies are needed. Message Although delirium is catalogued as a neurocognitive disorder, scientific evidence shows that it is also a motor disorder. The motor component of delirium should be taken into account when designing interventions or strategies to address delirium. These interventions may have a special importance in frail older adults. AbstractPurpose This article aims to analyze the intersections between delirium, physical exercise and rehabilitation, to better understand their interrelation and to visualize future lines of research. Methods In this narrative review, after an overview of brain neurophysiology and function, as common substrates to understand the relationship between delirium and physical function, we explore the scientific evidence in: (1) physical dysfunction as a risk factor for delirium; (2) physical dysfunction as a symptom of delirium and (3) functional consequences related to delirium. Later, we analyze the physical therapy as one of the main strategies in multicomponent interventions to prevent delirium, by examining intervention studies including rehabilitation, which have shown to be effective in managing delirium. Finally, we analyze how frailty, delirium and physical exercise interact with each other. Results This review confirms the close relationship between delirium and physical dysfunction; therefore, it is not surprising that physical exercise is widely used in delirium preventive strategies. Although delirium is catalogued as a neurocognitive disorder, scientific evidence shows that it is also a motor disorder, which is to be expected, since a vast body of literature already supports an interaction between motor and cognitive function. Conclusion The motor component of delirium should be taken into account when designing interventions or strategies to address delirium. These interventions may have a special importance in frail older adults.

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Section: Delirium Prevention By Targeting Frailty With Physical Exercisementioning

confidence: 99%

The role of physical exercise and rehabilitation in delirium

et al. 2020

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“…The items used in the template for the Delphi process were derived from programs which had been identified as best practice models for frailty prevention in Europe by the ADVANTAGE JA [7]: Capability Framework for Frailty Prevention-UK [8], Sunfrail Project [9], Frailty 360 ° Project [10], FACET Project [11], Frailty training events-UK [12], National Frailty Education Programme-Ireland [13], Frailty for Healthcare Professionals-UK [14], Frailty Training Programs-France [15], Education Module Frailty-UK [16], Postgraduate Certificate in Acute Care of the Older Person with Frailty-UK [17], MSc Specialist Practice Frail older Adults for Health and Social Care-UK [18], Training Programme for Health Care Professionals on detecting pre-frailty and recognizing the initial steps of frailty on primary care-Spain [19], +AGIL-Spain [20], Medical Science Frailty and Integrated Care-UK [21], Perssilaa Project [22] and Frailty Risk Screening in community dwelling older People-France [23]. The single capabilities outlined in the given curricula and catalogues were listed and merged by the core group (data not shown).…”

Section: Development Of the Templatementioning

confidence: 99%

European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty—a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS)

et al. 2020

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Background Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. Aim This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. Methods Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. Results The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. Discussion This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. Conclusions The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.

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“…Due to the relevance of mobility and instrumental activities of daily living in the prediction of adverse outcomes, community interventions based on physical and functional exercises should be prioritised to improve/maintain independence and quality of life in older adults [69,70].…”

Section: Recommendationsmentioning

confidence: 99%

“…Tackling polypharmacy and inappropriate prescriptions through deprescription processes at the primary care level should also be prioritised [70,71].…”

Section: Recommendationsmentioning

confidence: 99%

The Impact of Frailty on Admission to Home Care Services and Nursing Homes: Eight-Year Follow-Up of a Community-Dwelling, Older Adult, Spanish Cohort

Cegri

Orfila

Abellana

et al. 2020

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BackgroundFrailty in older adults is a common multidimensional clinical entity, a state of vulnerability to stressors that increases the risk of adverse outcomes such as functional decline, institutionalization or death. The aim of this study is to identify the factors that anticipate the future inclusion of community-dwelling individuals aged ≥70 years in home care programmes (HC) and nursing homes (NH), and to develop the corresponding prediction models. MethodsA prospective cohort study was conducted in 23 primary healthcare centers located in Catalonia, Spain, with an eight-year follow-up (2005-2013). The cohort was made up of 616 individuals. Data collection included a baseline multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic healthcare records, and the Central Registry of Catalonia for mortality. A prognostic index for a HC and NH at eight years was estimated for each patient. Death prior to these events was considered a competing risk event, and Fine–Gray regression models were used. Results At baseline, mean age was 76.4 years and 55.5% were women. During follow-up, 19.2% entered a HC program, 8.2% a NH, and 15.4% died without presenting an event. Of those who entered a NH, 31.5% had previously been in a HC program. Multivariate models for a HC and NH showed that the risk of a HC entry was associated with older age, dependence on the Instrumental Activities of Daily Living, and slow gait measured by Timed-up-and-go test. An increased risk of being admitted to a NH was associated with older age, dependence on the Instrumental Activities of Daily Living, number of prescriptions, and the presence of social risk.ConclusionsPrognostic models based on comprehensive geriatric assessments can predict the need for the commencement of HC and NH admission in community-dwelling older adults. Our findings underline the necessity to measure functional capacity, mobility, number of prescriptions, and social aspects of older adults in primary healthcare centers. In such a setting they can be offered longitudinal holistic assessments so as to benefit from preventive actions in order to remain independent in the community for as long as possible.

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Integrated primary and geriatric care for frail older adults in the community: Implementation of a complex intervention into real life

Cited by 34 publications

References 26 publications

The role of physical exercise and rehabilitation in delirium

The role of physical exercise and rehabilitation in delirium

European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty—a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS)

The Impact of Frailty on Admission to Home Care Services and Nursing Homes: Eight-Year Follow-Up of a Community-Dwelling, Older Adult, Spanish Cohort

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