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Post-discharge follow-up assessments of frail older people in their home environment: Is it feasible?

Martin Dreilich, Anne-Marie Boström, Elisabeth Rydwik

Abstract


Objectives: The aims of this study were to (1) assess the recruitment rate, drop-out, time to complete and acceptability of the test battery and evaluate the feasibility of follow-ups in the home environment and (2) describe the population in terms of sex, comorbidity, disability and frailty.

Methods: Participants were recruited from 3 geriatric departments and were assessed before discharge and in their homes at 1 and 3 months. The assessments consisted of: medical diagnoses; medications; risk of pressure ulcers, falls, malnutrition, depression and frailty; physical function, physical activity and health-related quality of life. Data on re-admission and home service were retrieved from the county council and the participating municipalities. Feasibility was evaluated by describing the recruitment process including inclusion/exclusion criteria, the participation rate and the number of and reasons for drop-out, the acceptance of the test battery, time taken and the feasibility of performing the tests in the participants’ homes.

Results: Thirty-five of 89 eligible patients agreed to participate (21 men/14 women). It took on average 70 minutes to complete the test battery at baseline and 124 minutes (including travel) at the home visits. The participants accepted the test battery. Mean age was 84 years and the women were significantly older than the men. The greatest number of the participants were regarded as frail, all had comorbidity and 77% had disability (n=27).

Conclusions: It was feasible to conduct the test battery at the ward and in the participant’s home. Frailty, comorbidity and disability were present simultaneously in almost half of the participants.

Keywords


Comprehensive Geriatric Assessment (CGA), frailty, geriatric care, health outcomes, health related quality of life, person-centered healthcare, post-discharge follow-up, walking ability

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References


European Medicines Agency. (2015). Points to consider on frailty: Evaluation instruments for baseline characterisation of clinical trial populations. EMA, London, UK.

Fried, L.P., Ferrucci, L., Darer, J., Williamson, J.D. & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. Journal of Gerontology Series A Biology Sciences & Medicine Sciences 59, 255-263.

Rubenstein, L.Z., Stuck, A.E., Siu, A.L. & Wieland, D. (1991). Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. Journal of the American Geriatric Society 39, 8S-16S; discussion 7S-8S.

Ellis, G., Whitehead, M.A., O'Neill, D., Langhorne, P. & Robinson, D. (2011). Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews (7):CD006211.

Beswick, A.D., Rees, K., Dieppe, P., Ayis, S., Gooberman-Hill, R., Horwood, J. & Ebrahim, S. (2008). Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 371, 725-735.

Clegg, A., Young, J., Iliffe, S., Rikkert, M.O. & Rockwood, K. (2013). Frailty in elderly people. Lancet 381, 752-762.

Edvardsson, D., Winblad, B. & Sandman, P. (2008). Person-centred care of people with severe Alzheimer's disease: current status and ways forward. Lancet Neurology 7, 362-367.

Fors, A., Ekman, I., Taft, C., Bjorkelund, C., Frid, K., Larsson, M.E.H., Thorn, J., Ulin, K., Wolf, A. & Swedberg, K. (2015). Person-centred care after acute coronary syndrome, from hospital to primary care - A randomised controlled trial. International Journal of Cardiology 187, 693-699.

Eldridge, S.M., Chan, C.L., Campbell, M.J., Bond, C.M., Hopewell, S., Thabane, L. & Lancaster, G.A. (2016). CONSORT 2010 statement: extension to randomised pilot and feasibility trials. British Medical Journal 355, i5239.

Lancaster, G.A., Dodd, S. & Williamson, P.R. (2004). Design and analysis of pilot studies: recommendations for good practice. Journal of Evaluation in Clinical Practice 10, 307-312.

van den Akker, M., Buntinx, F., Metsemakers, J.F., Roos, S. & Knottnerus, J.A. (1998). Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. Journal of Clinical Epidemiology 51, 367-375.

Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Koo, W.J., Burke, G., McBurnie, M.A. & Cardiovasular Health Study collabrative Research Group. (2001). Frailty in older adults: evidence for a phenotype. Journal of Gerontology Series A Biology Sciences & Medicine Sciences 56 (3) M146-M156.

Ek, A.C., Unosson, M. & Bjurulf, P. (1989). The modified Norton scale and the nutritional state. Scandinavian Journal of Caring Sciences 3, 183-187.

Olsson Möller, U., Kristensson, J., Midlöv, P., Ekdahl, C. & Jakobsson, U. (2012). Predictive Validity and Cut-Off Scores in Four Diagnostic Tests for Falls - A Study in Frail Older People at Home. Physical & Occupational Therapy in Geriatrics 30, 189-201.

Conradsson, M., Rosendahl, E., Littbrand, H., Gustafson, Y., Olofsson, B. & Lövheim, H. (2013). Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging and Mental Health 17, 638-645.

Folstein, M.F., Folstein, S.E. & McHugh, P.R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189-198.

Jones, C.J., Rikli, R.E. & Beam, W.C. (1999). A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport 70, 113-119.

Collen, F.M., Wade, D.T., Robb, G.F. & Bradshaw, C.M. (1991). The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. International Disability Studies 13, 50-54.

Gosman-Hedström, G. & Svensson, E. (2000). Parallel reliability of the functional independence measure and the Barthel ADL index. Disability and Rehabilitation 22, 702-715.

Burström, K., Sun, S., Gerdtham, U.G., Henriksson, M., Johannesson, M., Levin, L. & Zethraeus, N. (2014). Swedish experience-based value sets for EQ-5D health states. Quality of Life Research 23, 431-442.

Rubenstein, L.Z., Harker, J.O., Salvà, A., Guigoz, Y. & Vellas, B. (2001). Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). Journal of Gerontology Series A Biology Sciences & Medicine Sciences 56, M366-M372.

Hamilton, A., Balnave, R. & Adams, R. (1994). Grip strength testing reliability. Journal of Hand Therapy 7, 163-170.

Rydwik, E., Bergland, A., Forsén, L. & Frändin, K. (2012). Investigation into the reliability and validity of the measurement of elderly people's clinical walking speed: a systematic review. Physiotherapy and Theory in Practice 28, 238-256.

Forsén, L., Loland, N.W., Vuillemin, A., Chinapaw, M.J., van Poppel, M.N., Mokkink, L.B., van Mechelen, W. & Terwee, C.B. (2010). Self-administered physical activity questionnaires for the elderly: a systematic review of measurement properties. Sports Medicine 40, 601-623.

Washburn, R.A., Smith, K.W., Jette, A.M. & Janney, C.A. (1993). The Physical Activity Scale for the Elderly (PASE): development and evaluation. Journal of Clinical Epidemiology 46 (2) 153-162.

Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1 (3) 385-401.

Treweek, S., Lockhart, P., Pitkethly, M., Cook, J.A., Kjeldstøm, M., Johansen, M., Taskila, T.K., Sullivan, F.M., Wilson, S., Jackson, C., Jones, R. & Mitchell, E.D. (2013). Methods to improve recruitment to randomised controlled trials: Cochrane systematic review and meta-analysis. BMJ Open 3 (2) pii002360.

McMurdo, M.E., Roberts, H., Parker, S., Wyatt, N., May, H., Goodman, C., Jackson, S., Gladman, J., O’Mahony, S., Ali, K., Dickenson, E., Edison, P., Dyer, C. & Age and Ageing Speciality Group, NIHR, Comprehensive Clinical Research Network. (2011). Improving recruitment of older people to research through good practice. Age and Ageing 40 (6) 659-665.

Chatfield, M.D., Brayne, C.E. & Matthews, F.E. (2005). A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies. Journal of Clinical Epidemiology 58, 13-19.

Provencher, V., Mortenson, W.B., Tanguay-Garneau, L., Bélanger, K. & Dagenais, M. (2014). Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: a systematic review. Archives of Gerontology and Geriatrics 59, 18-24.

Koehler, M., Rabinowitz, T., Hirdes, J., Stones, M., Carpenter, G.I., Fries, B.E., Morris, J.N. & Jones, R.N. (2005). Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatrics 5, 1.

Squires, J.E., Hutchinson, A.M., Bostrom, A.M., Deis, K., Norton, P.G., Cummings, G.G. & Estabrooks, C.A. (2012). A data quality control program for computer-assisted personal interviews. Nursing Research and Practice 2012, 303816.

Djukanović, I., Sorjonen, K. & Peterson, U. (2015). Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden. Aging and Mental Health 19, 560-568.

Boström, G., Conradsson, M., Rosendahl, E., Nordström ,P,. Gustafson, Y. & Littbrand, H. (2014). Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people. Clinical Interventions in Aging 9, 249-256.

Lau, B.H.P., Kwan, J. & Cheung, K.S.L. (2016). Overlap of Frailty, Comorbidity, Disability, and Poor Self-Rated Health in Community-Dwelling Near-Centenarians and Centenarians. Journal of the American Geriatrics Society 64, 900-901.

Buta, B.J., Walston, J.D., Godino, J.G., Park, M., Kalyani, R.R., Xue, Q.L., Bandeen-Roche, K. & Varadhan, R. (2016). Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Research Reviews 26, 53-61.

Sutton, J.L., Gould, R.L., Daley, S., Coulson, M.C., Ward, E.V., Butler, A.M., Nunn, S.P. & Howard, R.J. (2016). Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review. BMC Geriatrics. 16, 55.

Benbassat, J. & Taragin, M. (2000). Hospital readmissions as a measure of quality of health care: advantages and limitations. Archives of Internal Medicine 160, 1074-1081.

Hijazi, H.H., Alyahya, M.S., Hammouri, H.M. & Alshraideh, H.A. (2017). Risk assessment of comorbidities on 30-day avoidable hospital readmissions among internal medicine patients. Journal of Evaluation in Clinical Practice 23, 391-401.

Urreta, I., Aranegi, P., Artetxe, J., Zubeldia, X., Huerta, I. & Emparanza, J.I. (2014). Intensive multidisciplinary care programme for frail patients. European Journal for Person Centered Healthcare 2, 274-281.

Kansagara, D., Englander, H., Salanitro, A., Kagen, D., Theobald, C., Freeman, M. & Kripalani, S. (2011). Risk prediction models for hospital readmission: a systematic review. Journal of the American Medical Association 306, 1688-1698.




DOI: http://dx.doi.org/10.5750/ejpch.v6i3.1494

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