<p>Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service: A Pragmatic Trial</p>

Abstract

BackgroundOlder adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult’s well-being.MethodsWe studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a “goal card” was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants.ResultsIn total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, −0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card.ConclusionEfforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.

Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation

“…Implementation research is essential for the successful translation of evidence-based interventions into practice. Using a mixed-methods strategy, we studied the extent to which MI and goal setting were performed within the Sage-atAge+ proactive assessment program for community-dwelling older adults (65+) to identify why we failed to show the hypothesized effect on well-being ( Rietkerk, Gerritsen, et al, 2019 ). In the current study, we showed that goal setting was prevalent, but that MI fidelity and the quality of goals were suboptimal, despite high motivation by care professionals.…”

“…In this mixed-methods implementation study, we aimed to identify the reasons for failure to achieve improved well-being in a previous study ( Rietkerk, Gerritsen, et al, 2019 ). We found that MI fidelity and goal quality were suboptimal despite a high prevalence of goal setting.…”

“…Mean frailty as measured with the GFI was 4.5 (±2.2). Details of the recruitment and selection procedure, as well as the participant characteristics, are published elsewhere ( Rietkerk, Gerritsen, et al, 2019 ).…”

“…Previously, we incorporated MI and goal setting in a proactive outpatient assessment service for frail community-dwelling older adults, called Sage-atAge+ (in Dutch, Wijs Grijs 2.0 ). Although we had sought to increase well-being through increased patient involvement and behavior change, the inclusion of these techniques had no additional effects on the physical, psychological, or social well-being of older adults ( Rietkerk Gerritsen, et al, 2019 ). However, before concluding that these strategies were ineffective, it is necessary to determine the extent to which they were actually applied.…”

Methods to elicit and evaluate the attainment of patient goals in older adults: A scoping review

“…In most studies the application of the elicitation method was preceded by one or more training sessions for the assessors [9,31,42,46,50,51,54,56,60,64,93,94,96,112]. Different formats of training were seen across papers, including e-learnings, seminars and webinars, and workshops.…”