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

Not Applicable

Withdrawn

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

• Registration Number: NCT05849870
• Lead Sponsor: Aberystwyth University

Brief Summary

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.

Detailed 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.

Study Timeline

• Status Verified: 2020-07
• Study Start: 2021-09-01
• Primary Completion: 2022-01-31
• Study Completion: 2022-05-30
• Study First Submitted: 2023-04-28
• Study First Submitted QC: 2023-04-28
• Last Update Submitted: 2023-04-28
• Study First Posted: 2023-05-09
• Last Update Posted: 2023-05-09

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Comprehensive Geriatric Assessment (CGA)	Frailty care pathway for older people in a rural primary care setting	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.
Functional Fitness Battery (FFB)	Frailty care pathway for older people in a rural primary care setting	Participants in this arm will undertake a Functional Fitness Battery, comprising physical assessments on the intrinsic capacity, lifestyle and nutritional status
Integrated Care for Older PEople (ICOPE)	Frailty care pathway for older people in a rural primary care setting	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.
Identification and Management of frailty and sarcopenia	Frailty care pathway for older people in a rural primary care setting	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.

Primary Outcome Measures

Name	Time	Method
Frequency of health care use	12 months	The number of hospital admissions and GP visits in the preceding 12 months
Recruitment rate (feasibility determination)	6 months	The recruitment rate reflects the recruitment method and number of eligible patients and general interest to take part.
Drop out rate (feasibility determination)	12 months	The drop out rate reflects the number of participants lost to follow up, response rates and adherence/compliance to the intervention.
electronic Frailty Index	12 months	This score reflects the number of accumulated deficits

Secondary Outcome Measures

Name	Time	Method
Usual Walking Speed	12 months	The average speed of walking at a usual pace over a short distance of several meters
Physical Activity Level	12 months	Quantified by the International Physical Activity Questionnaire (IPAQ)
Grip Strength	12 months	Maximal strength assessed using a hand held dynamometer

Trial Locations

Locations (1)

Aberystwyth University; 🇬🇧 Aberystwyth, Ceredigion, United Kingdom