One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; “Continuum of care for frail older people”

Abstract

BackgroundThe intervention; “Continuum of Care for Frail Older People”, was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person’s own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL).MethodsThe study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR).ResultsA total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 – 4.68) and (2.04, 95% CI; 1.03 – 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 – 0.98) compared to the control group.ConclusionsThe intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.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).…”

“…This includes a person-centered approach focusing on the individual’s needs by validated instruments (Table 1). A few clinical studies have indicated that frail elderly patients could benefit from a CGA, in a general elderly care context, as well as under more specific conditions, eg, ortho-geriatric care 12–17. Two meta-analyses showed no differences in mortality between patients treated in CGA units and in conventional care units 15,17.…”

Effects of a continuum of care intervention on frail older persons’ life satisfaction: a randomized controlled study

“…, Eklund et al . ). This was done because we assumed that respondents who declined to continue in our study had deteriorated health.…”

“…), as well as frailty and activities of daily living (ADL) (Eklund et al . ). The implementation of the intervention has also been studied, showing positive results on implementation fidelity (Hasson , Hasson et al .…”

Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults: a systematic review protocol

“…For this area have indicated that treating frailty in older adults is a realistic therapeutic goal. [21][22][23][24] However, it is still hard to determine how effective these types of intervention are and how efficiency can be influenced by other factors, for example, severity of the clinical condition. Another issue requiring clarification is the effectiveness of interventions in terms of drug prescription and changes in analytical parameters.…”