Home-visits From geRiatric tEam aFter hIp fracTure (REFIT)

The Effect of Home-visit Follow-up With a Multidisciplinary Geriatric Team in Old Patients With a Hip Fracture

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.

Study Overview

• Status: Active, not recruiting
• Conditions: Frailty; Hip Fractures; Geriatric Assessment; Old Age; Atrophy
• Intervention / Treatment: Other: Home visit and comprehensive geriatric assessment; Other: Control group, no designated follow up

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 Type: Interventional
• Enrollment (Actual): 200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Capital Region
    • Herlev, Capital Region, Denmark, 2730
      • Herlev and Gentofte Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 70 years to 120 years (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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 Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Geriatric home visit; Home-visit where a comprehensive geriatric assessment will be performed	Other: Home visit and comprehensive geriatric assessment; Home-visit from the geriatric team, who will do a full geriatric assessment and targeted interventions
Active Comparator: Standard care; No follow-up.	Other: Control group, no designated follow up; Only follow-up on patients own initiative with contact to the general practitioner

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to contact to the general practitioner or hospital because of a fall	Fall-related contact for treatment or assessment	90 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Contacts to a doctor	Number of contacts to a doctor (either hospital or the general practitioner)	90 days
Contacts to a doctor	Number of contacts to a doctor (either hospital or the general practitioner)	30 days
Falls	number of falls	30 days
Falls	number of falls	90 days
Preventable readmissions	Number of readmission deemed preventable by two blinded assessors	30 days
Number of drugs	Number of inappropriate drugs (Stop/Startt criteria)	30 days
Quality of life	Assessment of Quality of life using questionnaire (EQ VAS 0-100)	90 days
Patient satisfaction and fear of falling	Assessment patient satisfaction using questionnaire (Sat-UG-1)	30 days
Patient satisfaction and fear of faling	Assessment patient satisfaction using questionnaire (Sat-UG-1)	90 days
All cause mortaliy	Mortality	30 days
All cause mortaliy	Mortality	90 days
Muscle strength	Measured using "timed-up-and-go" test	90 days
Mobility	Assessed using the "new mobility score" (0-10, high is good)	90 days
Mobility	Assessed using the "Cumulated Ambulation Score" (0-6, high is good)	90 days
Weight	Change in weight i kilograms from discharge "Cumulated Ambulation Score", and "new mobility score"	90 days
Independence	Number of patients using walking aids	90 days
Independence	Number of patients with a new placement at a nursing homes	90 days

Collaborators and Investigators

• Sponsor: Herlev Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2021
• Primary Completion (Actual): April 1, 2022
• Study Completion (Anticipated): February 28, 2023

Study Registration Dates

• First Submitted: February 16, 2021
• First Submitted That Met QC Criteria: February 27, 2021
• First Posted (Actual): March 2, 2021

Study Record Updates

• Last Update Posted (Actual): May 20, 2022
• Last Update Submitted That Met QC Criteria: May 15, 2022
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Keywords: hip fracture; Geriatric assesment; Home-visit; Old patients
• Additional Relevant MeSH Terms: Pathologic Processes; Wounds and Injuries; Leg Injuries; Femoral Fractures; Hip Injuries; Frailty; Fractures, Bone; Hip Fractures
• Other Study ID Numbers: HgH_UGT_01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No