Post-acute Care for Patients With Frailty

Integrated Post-Acute Care Program for Frail Elderly

Acute illness could be enormous stress for frail people. Combining comprehensive geriatric assessment and multifactorial intervention has positive effects on frail community older adults. However, few studies investigated the effects of post-acute care (PAC) in frail older patients who just recovered from acute hospitalization. This study aimed to evaluate the effects of PAC on frail older adults in Taiwan.

Study Overview

• Status: Completed
• Conditions: Frailty; Retrospective Study
• Intervention / Treatment: Other: Post-acute care

Detailed Description

Frail patients aged >= 75 were recruited and divided into PAC or control groups. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention for two to four weeks. The control group received CGA only. The primary outcomes were 90-day emergency room visits, readmissions, and mortality after PAC.

• Study Type: Interventional
• Enrollment (Actual): 254
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taipei City, Taiwan
    • Taipei City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Mild to severe frailty identified by the Clinical Frailty Scale
2. Age ≥ 75 years
3. Diagnosis with Parkinson's disease, dementia, chronic obstructive pulmonary disease, or chronic kidney disease stage three or worse
4. Acute hospital stays between 3 to 30 days with deconditioning
5. Stable medical condition with no need of intensive care, laboratory examination, or oxygen dependence

Exclusion Criteria:

1. Refused to participate in the program
2. Candidate for other post-acute care programs (i.e. stroke, traumatic neurological injury, or fracture)
3. Unable to cooperate with the program due to mental or cognitive impairment
4. Long-term ventilator-dependence
5. Long-term bed-ridden status (> 6 months)
6. Diagnosed as end of life and in need of palliative care
7. Diagnosed as major illness (i.e. end-stage renal disease) and in need of frequent inpatient treatment ( > 3 times over recent 6 months)
8. Institutional residents
9. Home medical care participants

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Post-acute care; comprehensive geriatric assessment, and either home-based or hospital-based post-acute care	Other: Post-acute care; A personalized care program, focusing on managing geriatric syndromes and improving functional performances. Strength training, activities of daily living (ADL) and instrumental activities of daily living (IADL) practice, basic mobility training, reconditioning exercise, and home environment assessment and modification.
No Intervention: control group; comprehensive geriatric assessment only

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
90-day emergency room visits	Emergency room visits after post-acute care	90 days after post-acute care
90-day readmissions	Readmissions visits after post-acute care	90 days after post-acute care
90-day mortality	Mortality after post-acute care	90 days after post-acute care

Collaborators and Investigators

• Sponsor: Taipei City Hospital
• Investigators: Principal Investigator: Tai-Yin Wu, PhD, Department of Family Medicine, Taipei City Hospital, Zhongxing Branch

Study record dates

Study Major Dates

• Study Start (Actual): June 19, 2020
• Primary Completion (Actual): December 31, 2020
• Study Completion (Actual): December 31, 2020

Study Registration Dates

• First Submitted: July 6, 2022
• First Submitted That Met QC Criteria: July 6, 2022
• First Posted (Actual): July 11, 2022

Study Record Updates

• Last Update Posted (Actual): July 11, 2022
• Last Update Submitted That Met QC Criteria: July 6, 2022
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Frailty
• Other Study ID Numbers: TPECH-frailty

Drug and device information, study documents

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