Are Care Given by a Geriatric Hospital-Based Out Patient-Care Team Better Than Usual Care? - a Randomised Controlled Trial (The GerOP-Ca-trial)

Frailty and multimorbidity is one of the biggest challenges of todays health care due to the demographic development with more and more elderly surviving many diseases that was mortal just a few decades ago. Health care in Sweden is one of the best in the world, yet many frail older people do not receive appropriate health care. Several reports have described a fragmented care with lack of good quality due to lack of a holistic view on the patient and her situation. At the same time the care given is costly and ineffective with a lack of continuity. Additionally, there are a lack of hospital beds in Sweden due to the ageing population and a cut down of beds in the last decades.

There is though a method, Comprehensive Geriatric Assessment (CGA), where studies have shown many benefits for older patients including less need of hospital beds, better functional outcomes and a better chance of living at home after an Acute Hospital Discharge, but this method is not much used in Sweden.

The aim of this study is to show that CGA in an Out-patient Care Setting save hospital beds without decreasing the quality of care measured by sustained functional capacity. Other parameters to be evaluated are mortality, degree of frailty, health economy, quality of life, and cognition.

Survey of the field Frailty has become a central concept in elderly research in recent years. A common definition is a state of decreased reserve resistance to stressors as a result of cumulative decline across multiple physiological systems, causing vulnerability to different outcomes, such as falls, hospitalization, institutionalization and mortality. The prevalence of frailty increases with age and frail older people are at risk of further deterioration if their needs are not acknowledged. The Swedish National Board of Health and Welfare has given priority to the development and use of targeted needs assessment for the frail older people. Assessments that are both comprehensive and person-centred are required to achieve satisfactory and appropriate care to older people with complex needs.

Frailty is a dynamic condition, conceptualized as a continuum from not frail, to pre-frail, and frail. Those who are considered as pre-frail are more likely than non-frail to develop full frailty if no specific interventions are implemented. Appropriate nutrition and exercise are suggested as first-line treatments for frailty but other treatments should be considered depending on the individual causes of frailty. The goal is to identify needs and provide support to help older people to be as independent in their daily living as possible.