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| Name | Class |
|---|---|
| VinnVård | UNKNOWN |
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The present study "Continuum of care for frail elderly people" form part of the research programme "Support for frail elderly persons - from prevention to palliation" (www.vardalinstitutet.net) which comprises research into three interventions. The program comprises interventions addressing frail elderly people in different phases of the disablement process, from elderly people who are beginning to develop frailty to very frail elderly people receiving palliative care.
The intervention "Continuum of care for frail elderly people" addresses elderly people who are frail and that have a great risk of high health care consumption. The hypothesis is that an intervention program for frail elderly people can reduce the number of visits to the emergency department, increase the life satisfaction and maintain the functional ability. The intervention, including an early geriatric assessment at the emergency department, early family support, a case manager in the community with a multi-professional team and active follow-up by the case manager, contributes to early recognition of the elderly people's need of information, care and rehabilitation and of informal caregivers' need of information. It enhances the transfer of information and integrates the care between different caregivers and different care levels, thereby better recognize frail elderly people's needs. Specifically, this study is expected to show that the intervention has a positive effect on the frail elderly person's functional ability, life satisfaction, satisfaction with health and social care, and health care consumption.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional care, controlgroup | No Intervention | conventional care, control group | |
| integrated health care chain | Experimental | integrated health care chain. Geriatric assessment at emergency department (ED), case manager with multiprofessional team in the community, support for informal caregivers |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| integrated health care chain | Other | Geriatric assessment at ED, case manager with multiprofessional team in the community, support for informal caregivers |
|
| Measure | Description | Time Frame |
|---|---|---|
| Health Care Consumption | Number of hospital days and admission will be analysed | 1 year |
| Dependence in Activities of Daily Living | Changes in number of person dependent in one or more daily activity from baseline to follow-up. | 1 year |
| Satisfaction With Health and Social Care | 1 year |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Katarina Wilhelmson, MD,PhD | Göteborg University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Gothenburg | Gothenburg | 405 30 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23875866 | Derived | Eklund K, Wilhelmson K, Gustafsson H, Landahl S, Dahlin-Ivanoff S. One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial: "Continuum of care for frail older people". BMC Geriatr. 2013 Jul 22;13:76. doi: 10.1186/1471-2318-13-76. | |
| 22436121 | Derived | Hasson H, Blomberg S, Duner A. Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care. Implement Sci. 2012 Mar 22;7:23. doi: 10.1186/1748-5908-7-23. |
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exluded due to sheltered housing (n=2), dementia (n=1),palliative care (n=1) and died before baseline (n=4), declined particapation (n=12)
recrutment period October 2008 to July 2011
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| ID | Title | Description |
|---|---|---|
| FG000 | Conventional Care, Controlgroup | conventional care, control group |
| FG001 | Integrated Health Care Chain | integrated health care chain. Geriatric assessment at emergency department (ED), case manager with multiprofessional team in the community, support for informal caregivers integrated health care chain : Geriatric assessment at ED, case manager with multiprofessional team in the community, support for informal caregivers |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Conventional Care, Controlgroup | conventional care, control group |
| BG001 | Integrated Health Care Chain | integrated health care chain. Geriatric assessment at emergency department (ED), case manager with multiprofessional team in the community, support for informal caregivers integrated health care chain : Geriatric assessment at ED, case manager with multiprofessional team in the community, support for informal caregivers |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Health Care Consumption | Number of hospital days and admission will be analysed | Not Posted | 1 year | ||||||||||||
| Primary | Dependence in Activities of Daily Living | Changes in number of person dependent in one or more daily activity from baseline to follow-up. | Posted | Number | participants | 1 year |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Conventional Care, Controlgroup | conventional care, control group |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Professor Synneve Dahlin-Ivanoff ( Research leader) | Vårdalinstitute, University of Gothenburg | +46 31 7865733 | synneve.dahlin-ivanoff@gu.se |
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| 21569570 | Derived | Wilhelmson K, Duner A, Eklund K, Gosman-Hedstrom G, Blomberg S, Hasson H, Gustafsson H, Landahl S, Dahlin-Ivanoff S. Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people. BMC Geriatr. 2011 May 14;11:24. doi: 10.1186/1471-2318-11-24. |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
|
|
|
| Primary | Satisfaction With Health and Social Care | Not Posted | 1 year |
| 0 |
| 76 |
| 0 |
| 76 |
| EG001 | Integrated Health Care Chain | integrated health care chain. Geriatric assessment at emergency department (ED), case manager with multiprofessional team in the community, support for informal caregivers integrated health care chain : Geriatric assessment at ED, case manager with multiprofessional team in the community, support for informal caregivers | 0 | 85 | 0 | 85 |
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