Help Optimise and Mobilise Elders (H.O.M.E)

Study Overview
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Brief Summary
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During hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. This leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. The investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. As such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in Singapore. The investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid Type 2 design where both effectiveness and implementation spheres are tested simultaneously.

Detailed Description
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Aim 1: To examine the effectiveness of multicomponent, mobility-focused model of care in reducing iatrogenic complications and improving patient outcomes. Adopting the Institute for Healthcare Improvement's (IHI) 4Ms framework (Mobility, Mentation, Medication, and What Matters), the investigators will examine the effectiveness of timely and individually catered mobility interventions which not only increase mobilization but also optimize factors inhibiting mobility for elderly inpatients. It is hypothesized that the mobility outcomes, such as maximum distance walked and mobilization frequency will be significantly improved for patients who receive the intervention compared to those who receive standard care. Aim 2: To examine the cost impact of a mobility-focused model of care. The investigators will examine whether the cost of these multicomponent, mobility-focused interventions can be offset from cost savings from early mobilisation benefits, by comparing healthcare utilization costs between-groups. Further to that, a cost effectiveness analysis will be performed should functional effectiveness be observed. For the primary cost impact objective, it is hypothesized that the cost savings arising from reduction in bed days of hospitalization and other medical costs incurred during study period will outweigh the cost of implementing this model of care. In addition, it is also hypothesized that the proposed intervention will be cost-effective through achieving better functional outcomes for patients, with lower costs required. Aim 3: To evaluate the implementation outcomes of multicomponent, mobility-focused model of care in the process of this intervention. It is hypothesized that this intervention will have good acceptability, feasibility, penetration, implementation costs and sustainability.

Official Title
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Help Optimise and Mobilise Elders (H.O.M.E)

Conditions
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Mobility Limitation, Functional Disturbance

Intervention / Treatment
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* Other: Multicomponent, mobility-focused intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Newly admitted patients to the geriatric service Aged 75 years and above Mobile with or without the use of a walking aid Exclusion Criteria: Vancomycin-resistant enterococcus (VRE) status Requires droplet or airborne precautions Critically ill Haemodynamically instability Requires more than 4-hourly parameters Systolic blood pressure <90 mmHg Heart rate >100beats/min Non-ambulant patients With advanced dementia (Functional Assessment Staging Scale [FAST] 7 dementia) Fulfills direct admission to another subspecialty unit

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 110 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: It is a quasi-experimental design study.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Intervention group will receive a multicomponent, mobility-focused intervention during the course of inpatient admission. | Other: Multicomponent, mobility-focused intervention<br>* The intervention group will receive early therapist review (within one working day of admission to HOME unit), to be mobilised at least three times a day. They will also receive additional group exercise therapy sessions, as well as nurse screening for geriatric syndromes. Besides that, they will be screened for 4Ms (Mobility, Mentation, Medication, What Matters) by doctor on admission.<br>|
| No Intervention: Control<br>The control group will receive usual care as per current ward practice. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in maximum distance walked | The total distance covered by the research participant (in meter) | Upon admission and at the point of discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | 
| Mobilisation frequency | Number of times mobilised. The average mobilisation frequency will be calculated by dividing the sum by the number of admission days. | Through the duration of admission | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in modified barthel score | The score ranges from 0 to 100 with 0 as the worst outcome | Upon admission, at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay), and one-month post discharge | 
| Change in gait speed | 4 meter gait speed test (meter/second) | Upon admission and at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | 
| Inpatient length of stay and discharge location | The duration of admission (days) and the location the respective participant is discharged to | The duration of admission and upon discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | 
| Presence of common iatrogenic complications such as delirium, injurious falls, pressure ulcers, and venous thromboembolisms | Each of the complication will be measured in nominal scale; 0 denotes the absence of the complication while 1 denotes the presence of the complications. The total number of complications arise will be calculated. The greater the number indicates poorer outcome | At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | 
| Gross amount of patient's bill during index admission, considering subsidy level | The total gross amount of participant's bill during index admission. The subsidy level will be documented | At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | 
| The intervention related costs for group therapy | The number of group therapy sessions attended by the participant multiply by the cost for one group therapy session. The subsidy level will be documented. | At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Gait speed, Elderly, Geriatric, Mobility, Inpatient, Functional Decline, Mobility Intervention, Maximum distance walked, Cost impact, length of stay, Multidisciplinary, Implementation study, 4Ms (Mobility, Mentation, Medication, What Matters), Nursing screen, Group therapy