Comparing Frailty Care Pathways in Rural Primary Care: a Feasibility Study

Aberystwyth University

Status: Withdrawn

Conditions: Frailty

Treatments: Other: Frailty care pathway for older people in a rural primary care setting

Study type: Interventional

Funder types: Other

Identifiers

NCT05849870

16470 (Other Identifier)

Details and patient eligibility

About

Primary Care General Practitioners (GPs) are always looking at ways to improve the care of older people and ways to prevent older people from losing their independence. Pro-active provision of support often involves lifestyle advice and is a potentially important aspect of that, as it supports older people before acute care is needed. It's preventative caring, rather than reactive caring. But, implementing pro-active care is hampered by the high current workload of acute care, the uncertainty of 'what works' and whether patients are responsive to pro-active care plans. This project will explore different ways of providing pro-active support to older people who could be at risk of losing their independence and requiring frequent acute care. The benefits of pro-active care are arguably the greatest in these individuals.

Full description

This is randomised control trial design with a cluster randomisation, whereby each cluster (a GP surgery) will have a different intervention. As it's a feasibility study, there will only be one cluster per intervention.

Participants will be recruited from 4 local primary care surgeries, and if participants take part, they will have 4 visits, and will be randomly allocation of an intervention arm, or a control arm receiving usual care.

At the start, the participant would have 2 visits of a maximum of 2 hours to the participant's local GP surgery to undergo a variety of tasks and assessments about the participant's well-being, health and physical functioning. That could lead to an 'action plan' that is implemented. The participant will have the 3rd visit after 3 months, and a final (fourth) visit after 12 months. During the 3rd and 4th visit the participant will repeat various tasks and assessments done in visit 1 and 2.

The project comprises different activities in the different GP surgeries. The project compares different approaches that each surgery takes. Generally, each surgery will assess relevant aspects that are associated with 'getting older' and provide support in the coming months. The specific approaches are based on the Comprehensive Geriatric Assessment, the World Health Organisation's recommendation and resources for the Integrated Care of Older People (ICOPE) model, the recommendations from the International Conference of Frailty and Sarcopenia Research (ICFSR) and the Functional Fitness test battery. All of these approaches would lead to an 'personal care plan' developed by the medical student, with actions that are specific to the participant's circumstances.

Sex: All

Ages: 60 to 105 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

The study focuses on community-dwelling frail older people (≥ 60 years). Each GP surgery will complete the electronic Frailty Index (eFI) to stratify older people based on their level of frailty (non-frail, mildly frail, and frail). Participants will be stratified into four strata,

• participants without complex care needs and with a relatively low frailty level (non-frail);
• participants with some chronic conditions that could put them at risk in the future (mild frailty)
• frail participants at risk of complex care needs (frailty)
• participants with complex care needs (severe frailty).

Inclusion Criteria:

• adults aged 60 years or older
• mild frailty or frailty based on the eFI,
• without severe cognitive impairment diagnoses,
• not currently taking part in other research or in the previous 6 months,
• willing to provide informed consent

Exclusion Criteria:

1. are terminally ill
2. have severe cognitive or psychological impairments,
3. have experienced a severe, disabling stroke within the previous 6 months
4. are unable to communicate in English.
5. are currently taking part in other research project, or was part of research in the previous 6 months.
6. have experienced a heart attack, or unstable angina within the previous 3 months.
7. already receive advice that includes exercise and diet by health professionals and were referred at discharge for condition-specific rehabilitation (e.g. pulmonary rehabilitation, stroke rehabilitation) within the previous 6 months

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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0 participants in 5 patient groups

Comprehensive Geriatric Assessment (CGA)

Active Comparator group

Description:

Participants in this arm will undertake a Comprehensive Geriatric Assessment, and will be implemented based on Comprehensive Geriatric Assessment Toolkit for Primary Care Practitioners from the British Geriatrics Society. A personalised action plan will be developed and implemented based on the CGA.

Treatment:

Other: Frailty care pathway for older people in a rural primary care setting

Integrated Care for Older PEople (ICOPE)

Experimental group

Description:

Participants in this arm will undertake the assessment recommended by the World Health Organisation, and will be implemented by the publicly available app. A personalised action plan will be developed and implemented based on the ICOPE.

Treatment:

Other: Frailty care pathway for older people in a rural primary care setting

Identification and Management of frailty and sarcopenia

Experimental group

Description:

Participants in this arm will undertake the assessment recommended by the International Conference on Frailty and Sarcopenia Research Clinical Practice Guidelines for Identification and Management of physical frailty (ICFSR). A personalised action plan will be developed and implemented based on the ICFSR.

Treatment:

Other: Frailty care pathway for older people in a rural primary care setting

Functional Fitness Battery (FFB)

Experimental group

Description:

Participants in this arm will undertake a Functional Fitness Battery, comprising physical assessments on the intrinsic capacity, lifestyle and nutritional status

Treatment:

Other: Frailty care pathway for older people in a rural primary care setting

Usual Care

No Intervention group

Description:

Participants in this arm will not receive an intervention, but the usual care provided by the primary care provider.