Effectiveness of a randomized intervention by a geriatric team in frail hospital inpatients in non‐geriatric settings: FRAILCLINIC project

Abstract

Background: Little research has been undertaken on the benefits of frailty management within different hospital settings. The objective of this study is to provide evidence on the viability and effectiveness of frailty management in non‐geriatric hospital settings on mortality and functional decline after discharge. Methods: Data from the FRAILCLINIC (NCT02643069) study were used. FRAILCLINIC is a randomized controlled trial developed in non‐geriatric hospital inpatient settings (emergency room, cardiology and surgery) from Spain (2), Italy (2) and the United Kingdom (1). Inpatients must met frailty criteria (according to the Frailty Phenotype and/or FRAIL scale), ≥75 years old. The control group (CG) received usual care. The intervention group (IG) received comprehensive geriatric assessment (CGA) and a coordinated intervention consisting in recommendations to the treating physician about polypharmacy, delirium, falls, nutrition and physical exercise plus a discharge plan. The main outcomes included functional decline (worsening ≥5 points in Barthel Index) and mortality at 3 months. We used multivariate logistic regression models adjusted by age, gender and the Charlson index. Intention‐to‐treat (ITT) and per‐protocol (PP) analyses were used. Results: Eight hundred twenty one participants (IG: 416; mean age 83.00 ± 4.91; 51.44% women; CG: 405; mean age 82.46 ± 6.03; 52.35% women) were included. In the IG, 77.16% of the participants followed the geriatric team's recommendations as implemented by the treating physicians. The intervention showed a benefit on functional decline and mortality [OR: 0.67(0.47–0.96), P‐value 0.027 and 0.29(0.14–0.57), P‐value < 0.001, respectively) when fully followed by the treating physician. A trend to benefit (close to statistical significance) in functional decline and mortality were also observed when any of the recommendations were not followed [OR (95% CI): 0.72 (0.51–1.01), P‐value: 0.055; and 0.64 (0.37–1.10), P‐value: 0.105, respectively]. Conclusions: An individualized intervention in frail in‐patients reduces the risk of functional deterioration and mortality at 3 months of follow‐up when a care management plan is designed and followed.

Publication DOI: https://doi.org/10.1002/jcsm.13374
Divisions: College of Health & Life Sciences > School of Biosciences
College of Health & Life Sciences
College of Health & Life Sciences > Chronic and Communicable Conditions
Funding Information: This work was supported by grants from the European Commission Directorate General for Health and Consumer Affairs (DG SANTE) – Third Health Programme (grant agreement number), the Spanish Ministry of Economy, Industry and Competitiveness, co‐financed by
Additional Information: Copyright © 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords: Frailty,Hospitalization,Intervention,Functional decline,Mortality
Publication ISSN: 2190-6009
Last Modified: 17 May 2024 07:21
Date Deposited: 29 Nov 2023 17:08
Full Text Link:
Related URLs: https://onlinel ... 1002/jcsm.13374 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2023-11-28
Published Online Date: 2023-11-28
Accepted Date: 2023-10-18
Authors: Checa‐López, Marta
Costa‐Grille, Alba
Álvarez‐Bustos, Alejandro
Carnicero‐Carreño, Jose A.
Sinclair, Alan
Scuteri, Angelo
Landi, Francesco
Solano‐Jaurrieta, Juan José
Bellary, Srikanth (ORCID Profile 0000-0002-5924-5278)
Rodríguez‐Mañas, Leocadio

Download

[img]

Version: Published Version

License: Creative Commons Attribution

| Preview

Export / Share Citation


Statistics

Additional statistics for this record