Clinical trial NCT04777136: Home-visits From geRiatric tEam aFter hIp fracTure
Official title: The Effect of Home-visit Follow-up With a Multidisciplinary Geriatric Team in Old Patients With a Hip Fracture
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Geriatric Assessment
Hip Fractures
Frailty
Old Age; Atrophy
Keywords: Geriatric assesment
hip fracture
Home-visit
Old patients
Lead sponsor: Herlev Hospital
Sponsor class: OTHER
First posted: 2021-03-02
Enrollment: 200
Sex: ALL
Minimum age (years): 70
Maximum age (years): 120
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Home visit from the geriatric team
Primary purpose: PREVENTION

Brief summary: The primary objective is to examine the effect of multidisciplinary geriatric team home-visits as follow-up after a hip fracture in old patients. The hypothesis is that home-visits will reduce the number of falls, readmissions, prevent functional decline, optimize that medical treatment, and a higher degree of satisfaction and quality of life.

Detailed description: Among older individuals, falling is a strong predictor of frailty, morbidity, and mortality and may cause a fracture. Many older patients experience recurrent falls, further functional decline, and readmission within the first three months. Hence, fall-related visits to the hospital represent a "red flag" but are also an opportunity for targeted intervention and prevention of future falls. However, many older patients are only treated for fall-related injuries and discharged without fall risk assessment or evaluation, hence there is a need for follow-up with targeted fall assessment and intervention to prevent further falls.

Thus, the present project aims to examine the effect of home-visit follow-up of older frail patients discharged from the orthopedic ward with a hip fracture. Furthermore, we will explore the effect of a cross-sectorial collaboration between hospital and municipality in the patients' homes to prevent falls, readmissions, medicine-associated adverse effects, and physical deconditioning in old frail patients.

The present study is a interventional trial. The intervention will consist of a home visit within ten weekdays of the discharge, where a comprehensive geriatric assessment (CGA) will be performed. The team performing the CGA consist of a Geriatrician and an experienced geriatric nurse. CGA is an overall assessment of the patient taking account of; the presence and severity of comorbidity, the nutritional state, cognitive and functional status, review of current medications, and social measures. The purpose is to stabilize and optimize current as well as chronic conditions, and reduce the probability of adverse events and falls, and to secure interventions or changes persist through the transition from the secondary to the primary health care system. The assessment may lead to several interventions, including; medicine review (new medicine, change in current or discontinuation), initiation of a nutritional effort or contact to a dietitian, referral to other health care services (outpatient clinics, hospitals, or general practitioner), referral to physiotherapy and/or occupational therapy or optimization of home care.

Patients randomized to the control group will receive standard care, where the subsequent need for medical service or increased home care will require contact with the general practitioner or the municipality, at the patient's initiative.

Eligibility criteria: Inclusion Criteria:

* Age of 70 years or older
* Hip fracture
* Ability to provide informed consent
* Residence in one of three following municipalities: Gladsaxe, Rudersdal or Lyngby-Taarbæk

Exclusion Criteria:

* No ability to provide informed consent
* Patients, who dies within 48 hours of discharge
* Terminal patients

Nursing home residents

Primary outcomes:
measure: Time to contact to the general practitioner or hospital because of a fall
timeFrame: 90 days
Secondary outcomes:
measure: Contacts to a doctor
timeFrame: 90 days
measure: Contacts to a doctor
timeFrame: 30 days
measure: Falls
timeFrame: 30 days
measure: Falls
timeFrame: 90 days
measure: Preventable readmissions
timeFrame: 30 days
measure: Number of drugs
timeFrame: 30 days
measure: Quality of life
timeFrame: 90 days
measure: Patient satisfaction and fear of falling
timeFrame: 30 days
measure: Patient satisfaction and fear of faling
timeFrame: 90 days
measure: All cause mortaliy
timeFrame: 30 days
measure: All cause mortaliy
timeFrame: 90 days
measure: Muscle strength
timeFrame: 90 days
measure: Mobility
timeFrame: 90 days
measure: Mobility
timeFrame: 90 days
measure: Weight
timeFrame: 90 days
measure: Independence
timeFrame: 90 days
measure: Independence
timeFrame: 90 days
Other outcomes:
Locations:
city: Herlev
country: Denmark
facility: Herlev and Gentofte hospital
state: Capital Region
Study officials:
References: