Home-visits From geRiatric tEam aFter hIp fracTure

Not Applicable

• Conditions: Geriatric Assessment; Frailty; Hip Fractures; Old Age; Atrophy
• Interventions: Other: Control group, no designated follow up; Other: Home visit and comprehensive geriatric assessment

• Registration Number: NCT04777136
• Lead Sponsor: Herlev Hospital

Brief Summary

The primary objective is to examine the effect of multidisciplinary geriatric team home-visits as follow-up after a hip fracture in old patients. The hypothesis is that home-visits will reduce the number of falls, readmissions, prevent functional decline, optimize that medical treatment, and a higher degree of satisfaction and quality of life.

Detailed Description

Among older individuals, falling is a strong predictor of frailty, morbidity, and mortality and may cause a fracture. Many older patients experience recurrent falls, further functional decline, and readmission within the first three months. Hence, fall-related visits to the hospital represent a "red flag" but are also an opportunity for targeted intervention and prevention of future falls. However, many older patients are only treated for fall-related injuries and discharged without fall risk assessment or evaluation, hence there is a need for follow-up with targeted fall assessment and intervention to prevent further falls.

Thus, the present project aims to examine the effect of home-visit follow-up of older frail patients discharged from the orthopedic ward with a hip fracture. Furthermore, we will explore the effect of a cross-sectorial collaboration between hospital and municipality in the patients' homes to prevent falls, readmissions, medicine-associated adverse effects, and physical deconditioning in old frail patients.

The present study is a interventional trial. The intervention will consist of a home visit within ten weekdays of the discharge, where a comprehensive geriatric assessment (CGA) will be performed. The team performing the CGA consist of a Geriatrician and an experienced geriatric nurse. CGA is an overall assessment of the patient taking account of; the presence and severity of comorbidity, the nutritional state, cognitive and functional status, review of current medications, and social measures. The purpose is to stabilize and optimize current as well as chronic conditions, and reduce the probability of adverse events and falls, and to secure interventions or changes persist through the transition from the secondary to the primary health care system. The assessment may lead to several interventions, including; medicine review (new medicine, change in current or discontinuation), initiation of a nutritional effort or contact to a dietitian, referral to other health care services (outpatient clinics, hospitals, or general practitioner), referral to physiotherapy and/or occupational therapy or optimization of home care.

Patients randomized to the control group will receive standard care, where the subsequent need for medical service or increased home care will require contact with the general practitioner or the municipality, at the patient's initiative.

Study Timeline

• Study First Submitted: 2021-02-16
• Study First Submitted QC: 2021-02-27
• Study Start: 2021-03-01
• Study First Posted: 2021-03-02
• Primary Completion: 2022-04-01
• Status Verified: 2022-05
• Last Update Submitted: 2022-05-15
• Last Update Posted: 2022-05-20
• Study Completion: 2023-02-28

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 200

Inclusion Criteria

• Age of 70 years or older
• Hip fracture
• Ability to provide informed consent
• Residence in one of three following municipalities: Gladsaxe, Rudersdal or Lyngby-Taarbæk

Exclusion Criteria

• No ability to provide informed consent
• Patients, who dies within 48 hours of discharge
• Terminal patients

Nursing home residents

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Standard care	Control group, no designated follow up	No follow-up.
Geriatric home visit	Home visit and comprehensive geriatric assessment	Home-visit where a comprehensive geriatric assessment will be performed

Primary Outcome Measures

Name	Time	Method
Time to contact to the general practitioner or hospital because of a fall	90 days	Fall-related contact for treatment or assessment

Secondary Outcome Measures

Name	Time	Method
Independence	90 days	Number of patients with a new placement at a nursing homes
Patient satisfaction and fear of faling	90 days	Assessment patient satisfaction using questionnaire (Sat-UG-1)
Number of drugs	30 days	Number of inappropriate drugs (Stop/Startt criteria)
Contacts to a doctor	30 days	Number of contacts to a doctor (either hospital or the general practitioner)
Falls	90 days	number of falls
All cause mortaliy	90 days	Mortality
Preventable readmissions	30 days	Number of readmission deemed preventable by two blinded assessors
Mobility	90 days	Assessed using the "Cumulated Ambulation Score" (0-6, high is good)
Muscle strength	90 days	Measured using "timed-up-and-go" test
Weight	90 days	Change in weight i kilograms from discharge "Cumulated Ambulation Score", and "new mobility score"
Quality of life	90 days	Assessment of Quality of life using questionnaire (EQ VAS 0-100)
Patient satisfaction and fear of falling	30 days	Assessment patient satisfaction using questionnaire (Sat-UG-1)

Trial Locations

Locations (1)

Herlev and Gentofte hospital; 🇩🇰 Herlev, Capital Region, Denmark