Home-visits From geRiatric tEam aFter hIp fracTure

Study Overview
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Brief Summary
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The primary objective is to examine the effect of multidisciplinary geriatric team home-visits as follow-up after a hip fracture in old patients. The hypothesis is that home-visits will reduce the number of falls, readmissions, prevent functional decline, optimize that medical treatment, and a higher degree of satisfaction and quality of life.

Detailed Description
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Among older individuals, falling is a strong predictor of frailty, morbidity, and mortality and may cause a fracture. Many older patients experience recurrent falls, further functional decline, and readmission within the first three months. Hence, fall-related visits to the hospital represent a red flag but are also an opportunity for targeted intervention and prevention of future falls. However, many older patients are only treated for fall-related injuries and discharged without fall risk assessment or evaluation, hence there is a need for follow-up with targeted fall assessment and intervention to prevent further falls. Thus, the present project aims to examine the effect of home-visit follow-up of older frail patients discharged from the orthopedic ward with a hip fracture. Furthermore, we will explore the effect of a cross-sectorial collaboration between hospital and municipality in the patients' homes to prevent falls, readmissions, medicine-associated adverse effects, and physical deconditioning in old frail patients. The present study is a interventional trial. The intervention will consist of a home visit within ten weekdays of the discharge, where a comprehensive geriatric assessment (CGA) will be performed. The team performing the CGA consist of a Geriatrician and an experienced geriatric nurse. CGA is an overall assessment of the patient taking account of; the presence and severity of comorbidity, the nutritional state, cognitive and functional status, review of current medications, and social measures. The purpose is to stabilize and optimize current as well as chronic conditions, and reduce the probability of adverse events and falls, and to secure interventions or changes persist through the transition from the secondary to the primary health care system. The assessment may lead to several interventions, including; medicine review (new medicine, change in current or discontinuation), initiation of a nutritional effort or contact to a dietitian, referral to other health care services (outpatient clinics, hospitals, or general practitioner), referral to physiotherapy and/or occupational therapy or optimization of home care. Patients randomized to the control group will receive standard care, where the subsequent need for medical service or increased home care will require contact with the general practitioner or the municipality, at the patient's initiative.

Official Title
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The Effect of Home-visit Follow-up With a Multidisciplinary Geriatric Team in Old Patients With a Hip Fracture

Conditions
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Geriatric Assessment, Hip Fractures, Frailty, Old Age; Atrophy

Intervention / Treatment
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* Other: Home visit and comprehensive geriatric assessment
* Other: Control group, no designated follow up


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age of 70 years or older Hip fracture Ability to provide informed consent Residence in one of three following municipalities: Gladsaxe, Rudersdal or Lyngby-Taarbæk Exclusion Criteria: No ability to provide informed consent Patients, who dies within 48 hours of discharge Terminal patients Nursing home residents

Ages Eligible for Study
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Minimum Age: 70 Years
Maximum Age: 120 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Home visit from the geriatric team
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Geriatric home visit<br>Home-visit where a comprehensive geriatric assessment will be performed | Other: Home visit and comprehensive geriatric assessment<br>* Home-visit from the geriatric team, who will do a full geriatric assessment and targeted interventions<br>|
| Active Comparator: Standard care<br>No follow-up. | Other: Control group, no designated follow up<br>* Only follow-up on patients own initiative with contact to the general practitioner<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to contact to the general practitioner or hospital because of a fall | Fall-related contact for treatment or assessment | 90 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Contacts to a doctor | Number of contacts to a doctor (either hospital or the general practitioner) | 90 days | 
| Contacts to a doctor | Number of contacts to a doctor (either hospital or the general practitioner) | 30 days | 
| Falls | number of falls | 30 days | 
| Falls | number of falls | 90 days | 
| Preventable readmissions | Number of readmission deemed preventable by two blinded assessors | 30 days | 
| Number of drugs | Number of inappropriate drugs (Stop/Startt criteria) | 30 days | 
| Quality of life | Assessment of Quality of life using questionnaire (EQ VAS 0-100) | 90 days | 
| Patient satisfaction and fear of falling | Assessment patient satisfaction using questionnaire (Sat-UG-1) | 30 days | 
| Patient satisfaction and fear of faling | Assessment patient satisfaction using questionnaire (Sat-UG-1) | 90 days | 
| All cause mortaliy | Mortality | 30 days | 
| All cause mortaliy | Mortality | 90 days | 
| Muscle strength | Measured using timed-up-and-go test | 90 days | 
| Mobility | Assessed using the new mobility score (0-10, high is good) | 90 days | 
| Mobility | Assessed using the Cumulated Ambulation Score (0-6, high is good) | 90 days | 
| Weight | Change in weight i kilograms from discharge Cumulated Ambulation Score, and new mobility score | 90 days | 
| Independence | Number of patients using walking aids | 90 days | 
| Independence | Number of patients with a new placement at a nursing homes | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Geriatric assesment, hip fracture, Home-visit, Old patients