Post-acute Care for Patients With Frailty

Study Overview
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Brief Summary
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Acute illness could be enormous stress for frail people. Combining comprehensive geriatric assessment and multifactorial intervention has positive effects on frail community older adults. However, few studies investigated the effects of post-acute care (PAC) in frail older patients who just recovered from acute hospitalization. This study aimed to evaluate the effects of PAC on frail older adults in Taiwan.

Detailed Description
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Frail patients aged >= 75 were recruited and divided into PAC or control groups. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention for two to four weeks. The control group received CGA only. The primary outcomes were 90-day emergency room visits, readmissions, and mortality after PAC.

Official Title
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Integrated Post-Acute Care Program for Frail Elderly

Conditions
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Frailty, Retrospective Study

Intervention / Treatment
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* Other: Post-acute care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mild to severe frailty identified by the Clinical Frailty Scale Age ≥ 75 years Diagnosis with Parkinson's disease, dementia, chronic obstructive pulmonary disease, or chronic kidney disease stage three or worse Acute hospital stays between 3 to 30 days with deconditioning Stable medical condition with no need of intensive care, laboratory examination, or oxygen dependence Exclusion Criteria: Refused to participate in the program Candidate for other post-acute care programs (i.e. stroke, traumatic neurological injury, or fracture) Unable to cooperate with the program due to mental or cognitive impairment Long-term ventilator-dependence Long-term bed-ridden status (> 6 months) Diagnosed as end of life and in need of palliative care Diagnosed as major illness (i.e. end-stage renal disease) and in need of frequent inpatient treatment ( > 3 times over recent 6 months) Institutional residents Home medical care participants

Ages Eligible for Study
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Minimum Age: 75 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: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Post-acute care<br>comprehensive geriatric assessment, and either home-based or hospital-based post-acute care | Other: Post-acute care<br>* A personalized care program, focusing on managing geriatric syndromes and improving functional performances. Strength training, activities of daily living (ADL) and instrumental activities of daily living (IADL) practice, basic mobility training, reconditioning exercise, and home environment assessment and modification.<br>|
| No Intervention: control group<br>comprehensive geriatric assessment only | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 90-day emergency room visits | Emergency room visits after post-acute care | 90 days after post-acute care | 
| 90-day readmissions | Readmissions visits after post-acute care | 90 days after post-acute care | 
| 90-day mortality | Mortality after post-acute care | 90 days after post-acute care |