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One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people".

Eklund K, Wilhelmson K, Gustafsson H, Landahl S, Dahlin-Ivanoff S - BMC Geriatr (2013)

Bottom Line: There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up.At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 - 0.98) compared to the control group.The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: The intervention; "Continuum of Care for Frail Older People", was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person's own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL).

Methods: The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR).

Results: A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 - 4.68) and (2.04, 95% CI; 1.03 - 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 - 0.98) compared to the control group.

Conclusions: The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.

Trial registration: ClinicalTrials.gov: NCT01260493.

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Related in: MedlinePlus

Flow-chart of randomization, allocation, follow-ups and analysis for the study period.
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Figure 1: Flow-chart of randomization, allocation, follow-ups and analysis for the study period.

Mentions: During the inclusion period 1 445 older persons living in the municipality sought care at the emergency department. Of these, 343 persons met the inclusion criteria and were asked for participation, 181 persons consented to participate, 159 declined, and three were found to have dementia when further assessed. The flow of participants through the study is shown in the CONSORT diagram, Figure 1. At the time of the baseline assessment, twenty of the participants were not assessed; for reasons, see Figure 1. Thus, in all 161 participated in the study, of which 76 persons were allocated to the control group and 85 to the intervention group and were analysed throughout the study. The median age of the non-participants was somewhat lower than that of the participants, but the age range was similar. The most common reasons for not participating were that the study seemed too demanding. For other reasons see Figure 1. All participants assigned to intervention participated in it. All participants in the intervention group had care planning at home, 50% (n = 38) among the control group had care planning at hospital. There were no significant differences in baseline characteristics between the participants in the two study groups, see Table 2.


One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people".

Eklund K, Wilhelmson K, Gustafsson H, Landahl S, Dahlin-Ivanoff S - BMC Geriatr (2013)

Flow-chart of randomization, allocation, follow-ups and analysis for the study period.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750658&req=5

Figure 1: Flow-chart of randomization, allocation, follow-ups and analysis for the study period.
Mentions: During the inclusion period 1 445 older persons living in the municipality sought care at the emergency department. Of these, 343 persons met the inclusion criteria and were asked for participation, 181 persons consented to participate, 159 declined, and three were found to have dementia when further assessed. The flow of participants through the study is shown in the CONSORT diagram, Figure 1. At the time of the baseline assessment, twenty of the participants were not assessed; for reasons, see Figure 1. Thus, in all 161 participated in the study, of which 76 persons were allocated to the control group and 85 to the intervention group and were analysed throughout the study. The median age of the non-participants was somewhat lower than that of the participants, but the age range was similar. The most common reasons for not participating were that the study seemed too demanding. For other reasons see Figure 1. All participants assigned to intervention participated in it. All participants in the intervention group had care planning at home, 50% (n = 38) among the control group had care planning at hospital. There were no significant differences in baseline characteristics between the participants in the two study groups, see Table 2.

Bottom Line: There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up.At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 - 0.98) compared to the control group.The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: The intervention; "Continuum of Care for Frail Older People", was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person's own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL).

Methods: The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the municipality of Mölndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR).

Results: A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 - 4.68) and (2.04, 95% CI; 1.03 - 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 - 0.98) compared to the control group.

Conclusions: The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society.

Trial registration: ClinicalTrials.gov: NCT01260493.

Show MeSH
Related in: MedlinePlus