Comprehensive Geriatric Assessment for Frail Older People

Study Overview
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Brief Summary
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The present study Comprehensive Geriatric Assessment for frail older people in Swedish acute care settings - a randomized controlled study comprises two study arms: one intervention and one control group. It is a multicentre trial with 5 centres with diverse local conditions in different parts of Sweden, with an implementation study alongside. The intervention Comprehensive Geriatric Assessment (CGA) for frail older people addresses people 75 years and older who are seeking acute hospital care at the hospital emergency department, and who are identified as frail. The CGA intervention, including a multidisciplinary team that assesses the patients socio-demographic background, social network, health and medical history, medications, functional status, cognitive status, nutritional status, somatic status and psychosocial status including depression, as well as treatment and planning for discharge and follow-up, contributes to a person-centred, and a comprehensive assessment tailored for each person. The results of this study are expected to optimize the implementation of future complex interventions and lead to the improvement of the care, support and rehabilitation for frail older people with complex needs. This study will contribute to an evidence base for full scale implementation of CGA in Swedish hospital care. The process evaluation, aiming to provide insight into function and consequences of the intervention, why it works or fails, is an important part of the design that will contribute with insights into real life conditions that may be challenging in implementing CGA. The investigators will evaluate fidelity and quality of the implementation, clarify causal mechanisms and identify contextual factors associated with variation in outcomes. The development of screening for frailty and CGA are potential and important tools to identify needs of this older population, and to direct the right health care actions towards those in most need. The study will address the following research questions: Can Comprehensive Geriatric Assessment for frail older patients in Swedish acute hospital settings: increase/maintain independence, functional status, health related quality of life and life satisfaction? increase satisfaction with health care? reduce health care consumption? How feasible and acceptable are the study processes and procedures of CGA from the perspective of care givers and older persons in Swedish settings?

Official Title
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Comprehensive Geriatric Assessment for Frail Older People in Swedish Acute Care Settings: A Randomized Controlled Study

Conditions
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Dependency

Intervention / Treatment
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* Other: Comprehensive Geriatric Assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients 75 years and older seeking acute hospital care at the hospital emergency department will be screened for frailty. Exclusion Criteria: Those with symptoms of predefined diagnoses such as stroke, acute myocardial infarction and hip fractures, admitted through fast tracks directly to a designated ward without passing the emergency department.

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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CGA intervention<br>The CGA intervention will include multidisciplinary teams consisting of physician, nurse (RN), physiotherapist (PT), occupational therapist (OT) and social worker (SW). The team will work according to CGA, and have the primary and continuing responsibility for planning of hospital care and discharge. CGA will include assessment of socio-demographic background, social network, health and medical history, medications, functional status, cognitive status, nutritional status, somatic status and psychosocial status including depression, as well as treatment and planning for discharge and follow-up. | Other: Comprehensive Geriatric Assessment<br>* Comprehensive Geriatric Assessment intervention<br>|
| No Intervention: Control group<br>The control group receives usual hospital care, that is care given at an ordinary medical hospital ward, without the specialized multi-disciplinary team approach and CGA. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dependence in Activities of Daily Living (ADL-staircase) | Changes in number of person dependent in one or more daily activity from baseline to follow-up. | Baseline, 1-month follow-up, 6-month follow-up and 12-month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Capability (ICECAP-O) | Changes in scores of ICECAP-O from baseline to follow-up. | Baseline, 1-month follow-up, 6-month follow-up and 12-month follow-up | 
| Self-rated Health (SF-36) | Changes in number of person with good self-rated health from baseline to follow-up. | Baseline, 1-month follow-up, 6-month follow-up and 12-month follow-up | 
| Satisfaction with quality of care (Questionnaire) | Number of persons satisfied with quality of care | 1-month follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Activity of Daily Living (ADL), Comprehensive Geriatric Assessment, Elderly, Frailty, Randomized controlled study