Impact of a Multidimensional Intervention in Elderly Patients With Pneumonia

Study Overview
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Brief Summary
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The hypothesis of this study is that long-term outcome in elderly patients admitted with the diagnosis of community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) would improve with a multidimensional intervention including assessment of co-morbidities, nutritional, functional and cognitive status and immunization.

Detailed Description
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Detailed description published in Revista Española de Geriatría y Gerontología (see citation and link)

Official Title
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Impact of a Multidimensional Intervention in Elderly Patients With Pneumonia: a Prospective Randomized Controlled Trial.

Conditions
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Community-acquired Pneumonia, Healthcare-associated Pneumonia

Intervention / Treatment
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* Other: Multidimensional intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Elderly patients (aged 65 years and over), of either sex, not dependent for basic activities of daily living (Barthel index ≥60 points). Diagnosed with community-acquired pneumonia at the Emergency Department or Day Hospitals at Hospital de la Santa Creu I Santa Pau Admitted to hospital. Exclusion Criteria: Derived from other acute care hospitals. Patients with HIV infection. Neutrophil counter<1000/mm3 Transplanted patients. Barthel index<60 points. Terminal disease. No signed informed consent.

Ages Eligible for Study
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Minimum Age: 65 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Multidisciplinar intervention<br>Patients that will receive the multidimensional intervention during the ambulatory follow-up. | Other: Multidimensional intervention<br>* The patient will be cited 2 months after hospital discharge for a geriatric evaluation carried out by a geriatric nurse and an internist with geriatric training. The duration of the first visit is 45-60 minutes. The visit consists of: 1. Assessment of the pneumonia resolution, co-morbidities, aspiration risk, risk of multiresistant infections, and the immunization, functional and cognitive status. 2. An individualized intervention plan. The patient and family or caregiver will receive an educational intervention, a written report with the planned intervention and an educational leaflet. Those patients who require further assessment or follow up of the intervention will receive 1 or 2 more visits and all the patients will be cited one year after the first visit.<br>* Other names: Comprehensive geriatric assesment;|
| No Intervention: Conventional follow up<br>This is an observation only group and outpatient follow up will be indicated in accordance with usual and customary practices. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthcare resources utilization (readmissions and consultations to hospital and emergency department). | To achieve the variables related to the healthcare resource utilization, computarized medical records will be reviewed and all patients will be followed up by telephone interview one year after discharge.The cause for readmission will be recorded. | 1 year after hospital admission for pneumonia | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional status | Data will be obtained by review of medical records and telephone interview one year after discharge. Dependency in basic activities of daily living will be scored using the Barthel Index (Mahoney & Barthel. Maryland State Med J 14; 61-65) which measures the capacity to perform ten basic activities and gives a quantitative estimation of the patient level of dependency, scoring to 0 (totally dependent) to 100 (totally independent). | 1 year after hospital admission for pneumonia | 
| Institutionalization | Data will be obtained by review of medical records and telephone interview one year after discharge. | 1 year after hospital admission for pneumonia | 
| Survival | Data will be obtained by review of medical records and telephone interview to patient or relatives one year after discharge. | 1 year after hospital admission for pneumonia | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pneumonia, Intervention Studies, Aged, Aged, 80 and over, Geriatric Assessment