The Effects of a Health-social Partnership Program for Discharged Non-frail Older Adults

The Hong Kong Polytechnic University

Status: Completed

Conditions: Transition; Partner Communication

Treatments: Other: Usual care; Other: Complex interventions

Study type: Interventional

Funder types: Other

Identifiers

NCT04434742

HSP002

Details and patient eligibility

About

Previous studies supporting discharged patients are hospital-based which admission criteria tend to include mainly those with complex needs and/or specific disease conditions. This study captured the service gap where these non-frail older patients might have no specific medical problem upon discharge but they might encounter residual health and social issues when returning home.

Full description

Objective: To compare the effect of a community-based health-social partnership program with usual care for discharged community-dwelling non-frail older adults on their health-related quality of life, activities of daily living, depressive symptoms, and use of health services.

Design: A randomized controlled trial. Participants: Discharged community-dwelling non-frail older adults from an emergency medical ward in an intervention (n=37) and a control (n=38) group.

Interventions: Discharged older adults were randomized to receive usual care or complex interventions, including structured assessment, health education, goal empowerment, and care coordination supported by a health-social team.

Main measures: The outcomes were measured at pre-intervention (T1) and at three months post-intervention (T2) using the Medical Outcomes Study 12-item Short Form, the Modified Barthel Index and the Geriatric Depression Scale.

Enrollment: 75 patients

Sex: All

Ages: 60+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• resided in the service areas of the study hospital,
• were aged 60 or over,
• were cognitively competent with a score greater than 26 in the Montreal Cognitive Assessment Hong Kong version,
• were living at home before and after discharge from the hospital,
• had scores of <5 on the Clinical Frailty Scale (Note: a patient is considered to be non-frail if they have a score less than 5), and
• were fit for medical discharge

Exclusion criteria

• were not able to communicate,
• could not be reached by phone,
• were bed-bound,
• had active psychiatric problems,
• were already engaged in other structured health or social programs, and
• would not be staying in Hong Kong for the three months of the study

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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75 participants in 2 patient groups

Intervention group

Experimental group

Description:

The subjects in this group receive complex interventions, including structured assessment, health education, goal empowerment, and care coordination supported by a health-social team.

Treatment:

Other: Complex interventions

Control group

Other group

Description:

The control group received usual discharge care and community resources that were made available to them as appropriate. A monthly social call was made to each client in the control group in order to exclude social effects. The contents of the social call, such as asking about entertainment and clients' hobbies, were set in the protocol.

Treatment:

Other: Usual care