Ambulatory Geriatric Evaluation - Frailty Intervention Trial

Study Overview
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Brief Summary
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The main purpose of this randomised controlled trial is to study if a Comprehensive Geriatric Assessment (CGA) and follow up for community-dwelling elderly people can improve outcomes such as health and health-related quality of life among both patients and relatives, feeling of safety among both patients and relatives and reduce costs, compared with usual care.

Detailed Description
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Frail older adults are at increased risk of vulnerability and serious health problems. This leads to increased suffering and higher healthcare utilization. There are major gaps in the knowledge needed to create the most favourable care model for preventing frailty and increasing health-related of life. The purpose of this randomised controlled trial is to study if a Comprehensive Geriatric Assessment and follow up in community-dwelling elderly people can prevent frailty, hospitalisation and adverse effects of frailty, improve health and health-related quality of life, and reduce costs, compared with usual care. In a randomized, controlled trial with 24 months of follow-up, a total of 430 older adults with multimorbidity will be randomized into two groups. The intervention group will receive Comprehensive Geriatric Assessment and follow up and the same standard health care services as the control group. The Comprehensive Geriatric Assessment and follow up will be provides through an outpatient facility that tailors care from a holistic perspective and, based on each patient's individual needs in line with the policy program that Sweden's pensioners' organizations have presented in 2010 together with the Swedish Association of Geriatric Medicine. The team includes, among other things. a. geriatricians, nurses, physiotherapists, assistance officer, dietician, pharmacist and co-operation with the dental hygienist. The primary outcome is development of frailty and hospitalization. Secondary outcomes are adverse effects of frailty, health and health-related quality of life and costs. There is a knowledge gap of how health care can identify persons with frailty and risks for frailty and how to meet their specific care needs. The study aims to fill a clinically important knowledge gap that can guide further development of future care for older people with multi-morbidity and frailty. CGA is readily transferable to clinical practice.

Official Title
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Effectiveness of a Comprehensive CGA on Frailty in Community-dwelling Elderly People - A Randomised, Controlled Trial

Conditions
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Frail Elderly, Deaths

Intervention / Treatment
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* Procedure: The intervention group
* Procedure: control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elderly 75 years and above Have been hospitalized three or more times in the last 12 months Have three or more diagnoses in their medical records according to the International Classification of Diseases (ICD-10) Live in their own homes (not nursing home) in the municipality of Norrkoeping Accept to participate in the study. Exclusion criteria: - Fulfilling the inclusion criteria but living in a special accommodation for the elderly

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: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: The intervention group<br>The intervention group will receive Comprehensive Geriatric Assessment and follow up as a complement to the same standard health care services as the control group. The Comprehensive Geriatric Assessment and follow up will be provides through an outpatient facility that tailors care from a holistic perspective and, based on each patient's individual needs in line with the policy program that Sweden's pensioners' organizations have presented in 2010 together with the Swedish Association of Geriatric Medicine. The team includes, among other things. a. geriatricians, nurses, physiotherapists, assistance officer, dietician, pharmacist and co-operation with the dental hygienist. | Procedure: The intervention group<br>* Medical assessment (co-morbid condition, physical and neurological examination, medication review, nutrition, and blood-tests to identify anaemia, diabetes, metabolism and liver- and kidney function); assessment of functioning (ADL/IADL, fall risk), psychological assessment (cognitive decline and depression) and assessment of social and environmental conditions. The care plan is based on the CGA and will be individualised and carried out in discussion with the patient and his/her caregivers. The care will be carried out by an inter-professional Geriatric Team with employees from both the county council and the municipality. The team consists of a core team (including geriatrician and nurse) and a support team (including a social worker, occupational therapist, dietician, pharmacist, physiotherapist, and dental hygienist). The care will involve treatment for unstable medical conditions and support of patients and their caregivers. The team will have regular team conferences.<br>* Other names: Geriatric care team;|
| Placebo Comparator: Control group<br>The control group will receive care in the same way as usual meaning access to primary care, hospital in- and outpatient care and care received by the municipality. The only difference between the two groups are that the control group will not have access to the geriatric care team. | Procedure: control group<br>* No intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospitalisation | Number of hospitalisations and in-care stays during the trial | 24 months | 
| Frailty | Unintentional weight loss ≥5% of the previous year. Exhaustion is assessed by two questions from the Centre for Epidemiologic Studies-Depression Scale. Low physical activity includes assessment of habitual physical activity level by using the Swedish version of the International Physical Activity Questionnaire short version (IPAQ-S).Slow walking speed is determined from the better of two attempts at usual comfortable walking speed over 4 m with or without a walking aid. Weakness (muscle strength) is assessed by maximal grip strength. | 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognition | Cognition is assessed by the Mini-Mental State Examination | 0 and 24 months | 
| Symptoms | Symptoms experienced during the previous week (frequency, intensity, and distress) are assessed by the The Memorial Symptom Assessment Scale (MSAS), which measures 32 different symptoms. | 0 and 24 months | 
| Depression | Depression is assessed using the Geriatric Depression Scale (GDS-15 | 0 and 24 months | 
| Health related quality of life | Health related quality of life (HRQL) is assessed by using the Nottingham Health Profile, first part (NHP) and the generic EuroQol questionnaire (EQ-5D) | 0 and 24 months | 
| Nutrition | The Mini Nutritional Assessment form (MNA), is used to assess nutritional status. The MNA includes 18 items. | 0 and 24 months | 
| Activities of Daily Living | Barthels index | 0 and 24 months | 
| Falls | the patient is asked about falls in the last 6 months | 0 and 24 months | 
| Costs | 1) Contact and extent of contact with the municipality measured by working hours 2) Number of: visits to day-care centres, in-hospital stays (type of clinic and extent of these), visits to primary care facilities, geriatric ambulatories or other specialist ambulatories 3) Admissions to nursing care facilities | 24 months | 
| Feeling of security of the patient | Questionnaire | 0, 12 and 24 months | 
| Feeling of security of the relatives | Questionnaire | 0, 12 and 24 months | 
| Quality of life of relatives | Questionnaire | 0, 12 and 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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costs, quality of life, feeling of security, multiprofessional team, geriatric competence