Effectiveness and Implementation of a Primary Healthcare Intervention for Screening and Management of Multimorbidity and Frailty among Urban Older Adults of Bhubaneswar: The Multi-FrAME Study

Rationale: Population ageing in low-and middle-income countries (LMICs) such as India has led to a rise in multimorbidity and frailty which have a bidirectional association affecting the quality of life. However, lack of specific intervention prohibits these individuals from getting additional support beyond disease oriented standard care. Novelty: There is a paucity of evidence on interventions for multimorbidity and frailty in low-and middle income settings which necessitates the development and testing of such an intervention and evaluating its implementation at primary healthcare levels. Objectives: To co-design and test the effectiveness of a primary healthcare intervention package for multimorbidity and frailty assessment & management among elderly (Multi-FrAME) on progression of frailty, functional ability, and patient-reported outcome measures (health-related quality of life, healthcare utilization, and life satisfaction). We will also evaluate the fidelity, acceptability, adoption, and sustainability of Multi-FrAME intervention. Methods: We propose the development and testing the effectiveness and implementation of a primary care based Multi-FrAME intervention package, by following three stages: a) Intervention Development, b) testing effectiveness of the intervention, c) implementation assessment. A Cluster Randomized Controlled Trial where we will randomly allocate the Health and Wellness Centers (HWCs) in Bhubaneswar city into intervention and control groups would be undertaken. Participants (≥60 years) residing within urban area of Bhubaneswar with multimorbidity and some degree of frailty will be included. Expected Outcome: This study will develop a primary care based intervention package, and generate evidence on its effectiveness and implementability which could further be deployed in other countries/similar settings.