Frailty and Complexity Among Home Service Recipients

Study Overview
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Brief Summary
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The purpose of the study is to develop frailty and complexity computation algorithms based on the French version of the interRAI-HC and, in doing so, to provide homecare nurses with valid and reliable screening tools for their routine practice. By relying on a prospective observational case-control longitudinal study, the study intends to assess the predictive validity of the proposed indices with respect to undesirable health outcomes. Repeated measurement occasions, separated by 6-month intervals, will also allow for estimation of intra-individual change in frailty and complexity. In the study, elders living in the community and aged 65 or older are the target population, and three samples will be considered based on the a priori risks of adverse outcomes (case 1: formal home service recipients; case 2: formal home care recipients; control: free of formal home care or service). These groups will be compared on the observed rates of frailty and complexity and on their evolution over time. Results will allow for identification of subgroups of the aged population for whom early screening of frailty and complexity appears most relevant. Based on the findings, practice guideline will be proposed. They will entail the interpretation of the scores and recommendations for mounting adapted preventive strategies. Finally, the study will contribute to enhancing knowledge on the relation between frailty, a well-known concept in gerontology, and complexity, a concept increasingly referred to in the care literature but that still deserves operational and consensual definitions.

Official Title
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Frailty and Complexity Among Home Service Recipients: a Case-control Longitudinal Study

Conditions
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Frail Elderly Syndrome

Intervention / Treatment
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* Other: interRAI-HC assessments


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: living in the community (private home) resident of Canton Geneva, Switzerland ability to hold a conversation in French (expression, comprehension) oriented in time and space Exclusion Criteria: living in hospital / nursing home not resident of Canton Geneva, Switzerland not fluent in French disoriented in time and space person under tutorship

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Case 1: formal home service recipients<br>Adults aged 65 or older living at home who receive formal home service (household, meal delivery, transportation, shopping) at least one a week | Other: interRAI-HC assessments<br>* Standardized geriatric assessments done with the interRAI-HC instrument (Canadian French version 9.1) by trained nurses<br>|
| Case 2: formal home care recipients<br>Adults aged 65 or older living at home who receive formal home care (shower/bath nursing assistance, nursing care) at least once a week | Other: interRAI-HC assessments<br>* Standardized geriatric assessments done with the interRAI-HC instrument (Canadian French version 9.1) by trained nurses<br>|
| Control: free of formal home care or home service<br>Adults aged 65 or older living at home who do not receive formal home care or home service. | Other: interRAI-HC assessments<br>* Standardized geriatric assessments done with the interRAI-HC instrument (Canadian French version 9.1) by trained nurses<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frailty Index | Index with a value ranging from 0 to 100, computed as the sum of health deficits recorded with the interRAI-HC MDS divided by the number of deficits considered. Replication of Ludwig and Busnel, BMC, 2017 (REF2) | at baseline | 
| Complexity Index | Index with a value ranging from 0 to 100, computed as the sum of complexity items recorded with the interRAI-HC MDS divided by the number of items considered. | at baseline | 
| Change in frailty Index | Change in the frailty index value; Expressed as a proportion, with the frailty index value at baseline as denominator and the observed frailty value as numerator. | at 6 months and at 12 months | 
| Change in complexity Index | Change in the complexity index value; Expressed as a proportion, with the complexity index value at baseline as denominator and the observed complexity value as numerator. | at 6 months and at 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with falls | Number of participants with falls in the 6 months prior each follow-up assessment (yes/no; if yes, number of falls that occurred); recorded prospectively by means of a life history calendar. | at 6 month, at 12 months | 
| Number of participants with hospitalizations | Number of participants with hospitalizations in the 6 months prior each follow-up assessment (yes/no; if yes, number of hospitalizations that occurred and lengths in days); recorded prospectively by means of a life history calendar. | at 6 month, at 12 months | 
| Number of participants with physician visits | Number of participants with physician visits in the 6 months prior each follow-up assessment (yes/no; if yes, number of visits that occurred); recorded prospectively by means of a life history calendar. | at 6 month, at 12 months | 
| Number of participants with emergency admissions | Number of participants with emergency admissions in the 6 months prior each follow-up assessment (yes/no; if yes, number of admissions that occurred); recorded prospectively by means of a life history calendar. | at 6 month, at 12 months | 
| Mortality rate | Number of deaths (yes/no); collected from relatives or through public databases (www.hommages.ch). | at 6 month, at 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Home Care Services, Geriatric Assessment, Aging, Frailty, Complexity, Nursing