Precision Care for Older Persons

Precision Care for Older Persons With Hip Fractures

This study aims to 1) develop an Advanced Person-Centered (APC) Smart Home Care Model that is able to predict patient outcomes; and 2) evaluate the effectiveness of this model by assessing improvements in care and recovery for older individuals post hip fracture.

Study Overview

• Status: Not yet recruiting
• Conditions: Hip Fractures
• Intervention / Treatment: Behavioral: Advanced Person-Centered (APC) Smart Home Care Model

Detailed Description

The APC Smart Home Care Model will be developed as follows: a) incorporate a prediction system based on ML data available from our prior studies; b) incorporate an enhanced feedback system using results from the prediction system, which will allow family caregivers to receive timely alerts and facilitate interactions between home care nurses and caregivers; and c) the APC prediction system will be further developed to allow for implementation of targeted home nursing interventions that can be individualized to meet the specific needs of each family caregiver and the person recovering from hip fracture. A mixed-methods approach will be employed to examine the effectiveness of the system, using a combination of quantitative and qualitative data.

• Study Type: Interventional
• Enrollment (Estimated): 218
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yea-Ing Shyu, PhD; Phone Number: +886978697460; Email: yeaing@mail.cgu.edu.tw
• Study Contact Backup: Name: Jersey Liang, PhD; Email: jliang@umich.edu

Study Locations

• Taiwan
  • Taiwan
    • New Taipei City, Taiwan, Taiwan, 106
      • Tuchen Branch Chang Gung Hospital
      • Contact: Yea-Ing Shyu; Phone Number: 0978697460; Email: yeaing@mail.cgu.edu.tw
      • Contact: Chen-June Seak, MS, MD; Email: julianseak@hotmail.com
    • Taoyuan District, Taiwan, Taiwan, 33302
      • Linkuo Chang Gung Memorial Hospital
      • Contact: Yea-Ing Shyu, PhD; Phone Number: 0978697460; Email: yeaing@mail.cgu.edu.tw
      • Contact: Yu-Chih Lin, Master; Email: b101092127@tmu.edu.tw
      • Sub-Investigator: Yu-Chih Lin, Master

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. ≥ 60 years old,
2. had been transferred from the emergency department to the hospital due to a unilateral hip fracture,
3. repair of the hip fracture involved either hip arthroplasty or internal fixation, 4) their primary place of residence was northern Taiwan

Exclusion Criteria:

1. severity of cognitive impairment (a CMMSE score of < 10),
2. known to be terminally ill,
3. has no primary family caregiver,
4. residing in an institutional care facility

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Advanced Person-Centered (APC) Smart Home Care Model; Smart cloth assisted Home Care will be tailored to the needs of the individual with hip fracture and promptly administered. Continuous monitoring of clinical data will identify deviations from a patient's daily routine, which will guide ML-predictions of adverse outcomes and facilitate proactive health interventions by home nurses. Real-time feedback to caregivers will be provided via an app, providing timely alerts and ensuring swift and appropriate action.	Behavioral: Advanced Person-Centered (APC) Smart Home Care Model; Enhanced Smart Care Model (SCM) that incorporates precise predictions of adverse outcomes and improvements in the real-time feedback system for caregivers and person-center home-based nursing.
No Intervention: Usual care; Routine hospital care following hip fracture surgery without smart cloth care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fall Incidents.	number of falls	1st month following discharge
Fall Incidents.	number of falls	3rd month following hospital discharge
Fall insidents	number of falls	6th month following hospital discharge
Fall incidents	Number of falls	12th month following hospital discharge
Fall incidents	Number of falls	18th month following hospital discharge
Fall incidents	Number of falls	24th month following hospital discharge
range of motion	The clinical outcomes to be assessed include range of motion (ROM) in the affected limb in degree	1st month following hospital discharge
Muscle strength of affected limb	maximum amount of force that a muscle can generate during a single contraction. The unit is weights.	1st month following hosptial discharge
Visual analog of Pain score	patient self-report that collected by assessor. Score range 0-100, with higher score indicating more pain.	1st month following hospital discharge
Barthel Index	assessor measures functional indepdencen in activities of daily living (ADLs) of the patient, score range 0-100, higher score indicate more independent.	1st month following discharge
Lawton IADL scale	Instrumental activities of daily living (ADLs) collected by assessor. Score rage from 0 tto 8, with 8 indicating more independent function.	1st month following discharge
Caregiver balance	The perception of caregivers regarding their ability to manage conflicting caregiving demands. Score range 1-3, with higher score indicating more balance.	1st following hospital discharge
Caregiver balance	The perception of caregivers regarding their ability to manage conflicting caregiving demands. Score range 1-3, with higher score indicating more balance.	3rd month following hospital discharge
Caregiver Balance	The perception of caregivers regarding their ability to manage conflicting caregiving demands. Score range 1-3, with higher score indicating more balance.	6th month following hospital discharge
Caregiver Balance	The perception of caregivers regarding their ability to manage conflicting caregiving demands. Score range 1-3, with higher score indicating more balance.	12th month following hospital discharge
Caregiver Balance	The perception of caregivers regarding their ability to manage conflicting caregiving demands. Score range 1-3, with higher score indicating more balance.	18th month following hospital discharge
Caregiver Balance	The perception of caregivers regarding their ability to manage conflicting caregiving demands. Score range 1-3, with higher score indicating more balance.	24 month following hospital discharge
Caregiver preparedness	Caregiver readiness to handle caregiving responsibilities and associated stresses. Score range 0-32, with higher score indicating more prepared.	1st month following hospital discharge
Caregiver preparedness	Caregiver readiness to handle caregiving responsibilities and associated stresses. Score range 0-32, with higher score indicating more prepared.	3rd month following hospital discharge
Caregiver Preparedness	Caregiver readiness to handle caregiving responsibilities and associated stresses. Score range 0-32, with higher score indicating more prepared.	6th month following hospital discharge
Caregiver Preparedness	Caregiver readiness to handle caregiving responsibilities and associated stresses. Score range 0-32, with higher score indicating more prepared.	12 month following hospital discharge
Caregiver preparedness	Caregiver readiness to handle caregiving responsibilities and associated stresses. Score range 0-32, with higher score indicating more prepared.	18th month following hospital discharge
range of motion	The clinical outcomes to be assessed include range of motion (ROM) in the affected limb in degree	3rd month following hospital discharge
Caregiver Preparedness	Caregiver readiness to handle caregiving responsibilities and associated stresses. Score range 0-32, with higher score indicating more prepared.	24th month following hospital discharge
range of motion	The clinical outcomes to be assessed include range of motion (ROM) in the affected limb in degree	6th month following hospital discharge
range of motion	The clinical outcomes to be assessed include range of motion (ROM) in the affected limb in degree	12th month following hospital discharge
range of motion	The clinical outcomes to be assessed include range of motion (ROM) in the affected limb in degree	18th month following hospital discharge
range of motion	The clinical outcomes to be assessed include range of motion (ROM) in the affected limb in degree	24th month following hospital discharge
Muscle strength of affected limb	maximum amount of force that a muscle can generate during a single contraction. The unit is weights.	3rd month following hosptial discharge
Muscle strength of affected limb	maximum amount of force that a muscle can generate during a single contraction. The unit is weights.	6th month following hosptial discharge
Muscle strength of affected limb	maximum amount of force that a muscle can generate during a single contraction. The unit is weights.	12th month following hosptial discharge
Muscle strength of affected limb	maximum amount of force that a muscle can generate during a single contraction. The unit is weights.	18th month following hosptial discharge
Muscle strength of affected limb	maximum amount of force that a muscle can generate during a single contraction. The unit is weights.	24th month following hosptial discharge
Visual analog of Pain score	patient self-report that collected by assessor. Score range 0-100, with higher score indicating more pain.	3rd month following hospital discharge
Visual analog of Pain score	patient self-report that collected by assessor. Score range 0-100, with higher score indicating more pain.	6th month following hospital discharge
Visual analog of Pain score	patient self-report that collected by assessor. Score range 0-100, with higher score indicating more pain.	12th month following hospital discharge
Visual analog of Pain score	patient self-report that collected by assessor. Score range 0-100, with higher score indicating more pain.	18th month following hospital discharge
Visual analog of Pain score	patient self-report that collected by assessor. Score range 0-100, with higher score indicating more pain.	24th month following hospital discharge
Barthel Index	assessor measures functional indepdencen in activities of daily living (ADLs) of the patient, score range 0-100, higher score indicate more independent.	3rd month following discharge
Barthel Index	assessor measures functional indepdencen in activities of daily living (ADLs) of the patient, score range 0-100, higher score indicate more independent.	6th month following discharge
Barthel Index	assessor measures functional indepdencen in activities of daily living (ADLs) of the patient, score range 0-100, higher score indicate more independent.	12th month following discharge
Barthel Index	assessor measures functional indepdencen in activities of daily living (ADLs) of the patient, score range 0-100, higher score indicate more independent.	18 month following discharge
Barthel Index	assessor measures functional indepdencen in activities of daily living (ADLs) of the patient, score range 0-100, higher score indicate more independent.	24th month following discharge
Lawton IADL scale	Instrumental activities of daily living (ADLs) collected by assessor. Score rage from 0 tto 8, with 8 indicating more independent function.	3rd month following discharge
Lawton IADL scale	Instrumental activities of daily living (ADLs) collected by assessor. Score rage from 0 tto 8, with 8 indicating more independent function.	6th month following discharge
Lawton IADL scale	Instrumental activities of daily living (ADLs) collected by assessor. Score rage from 0 tto 8, with 8 indicating more independent function.	12 month following discharge
Lawton IADL scale	Instrumental activities of daily living (ADLs) collected by assessor. Score rage from 0 tto 8, with 8 indicating more independent function.	18 month following discharge
Lawton IADL scale	Instrumental activities of daily living (ADLs) collected by assessor. Score rage from 0 tto 8, with 8 indicating more independent function.	24 month following discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
number of visits to emergency department	collected by assessor asking family members	1st month following hospital discharge
number of hospital readmission	collected by assessor by asking family members	1st month following hospital discharge
Cognitive function	Cognitive function following hip-fracture surgery will be assessed using the Taiwan version of the Mini Mental State Examination. Score ranges 0-30, with higher score indicating better cognitive function.	1st month following hospital discharge
Cognitive function	Cognitive function following hip-fracture surgery will be assessed using the Taiwan version of the Mini Mental State Examination. Score ranges 0-30, with higher score indicating better cognitive function.	3rd month following hospital discharge
Cognitive function	Cognitive function following hip-fracture surgery will be assessed using the Taiwan version of the Mini Mental State Examination. Score ranges 0-30, with higher score indicating better cognitive function.	6th month following hospital discharge
Cognitive function	Cognitive function following hip-fracture surgery will be assessed using the Taiwan version of the Mini Mental State Examination. Score ranges 0-30, with higher score indicating better cognitive function.	12th month following hospital discharge
Cognitive function	Cognitive function following hip-fracture surgery will be assessed using the Taiwan version of the Mini Mental State Examination. Score ranges 0-30, with higher score indicating better cognitive function.	18th month following hospital discharge
Cognitive function	Cognitive function following hip-fracture surgery will be assessed using the Taiwan version of the Mini Mental State Examination. Score ranges 0-30, with higher score indicating better cognitive function.	24th month following hospital discharge
Depressive symptoms	Patients' depressive symptoms will be evaluated using the 15-item Geriatric Depression Scale, short form (GDS-SF). Score range 0-15, with higher score indicating higher depressive symptoms.	1st month following hospital discharge
Depressive symptoms	Patients' depressive symptoms will be evaluated using the 15-item Geriatric Depression Scale, short form (GDS-SF). Score range 0-15, with higher score indicating higher depressive symptoms.	3rd month following hospital discharge
Depressive symptoms	Patients' depressive symptoms will be evaluated using the 15-item Geriatric Depression Scale, short form (GDS-SF). Score range 0-15, with higher score indicating higher depressive symptoms.	6th month following hospital discharge
Depressive symptoms	Patients' depressive symptoms will be evaluated using the 15-item Geriatric Depression Scale, short form (GDS-SF). Score range 0-15, with higher score indicating higher depressive symptoms.	12th month following hospital discharge
Depressive symptoms	Patients' depressive symptoms will be evaluated using the 15-item Geriatric Depression Scale, short form (GDS-SF). Score range 0-15, with higher score indicating higher depressive symptoms.	18th month following hospital discharge
Depressive symptoms	Patients' depressive symptoms will be evaluated using the 15-item Geriatric Depression Scale, short form (GDS-SF). Score range 0-15, with higher score indicating higher depressive symptoms.	24th month following hospital discharge
Nutritional Status	The 18-item Mini Nutritional Assessment (MNA). Score range 0-30, with higher score indicating better nutritioanl status.	1st month following hospital discharge
Nutritional Status	The 18-item Mini Nutritional Assessment (MNA). Score range 0-30, with higher score indicating better nutritioanl status.	3rd month following hospital discharge
Nutritional Status	The 18-item Mini Nutritional Assessment (MNA). Score range 0-30, with higher score indicating better nutritioanl status.	6th month following hospital discharge
Nutritional Status	The 18-item Mini Nutritional Assessment (MNA). Score range 0-30, with higher score indicating better nutritioanl status.	12th month following hospital discharge
Nutritional Status	The 18-item Mini Nutritional Assessment (MNA). Score range 0-30, with higher score indicating better nutritioanl status.	18th month following hospital discharge
Nutritional Status	The 18-item Mini Nutritional Assessment (MNA). Score range 0-30, with higher score indicating better nutritioanl status.	24th month following hospital discharge
Health-Related Quality of Life (HRQoL)	Taiwan version of the 36-item Short Form Survey (SF-36). Score range 0-100, with higher score indicating better health outcomes.	1st month following hospital discharge
Health-Related Quality of Life (HRQoL)	Taiwan version of the 36-item Short Form Survey (SF-36). Score range 0-100, with higher score indicating better health outcomes.	3rd month following hospital discharge
Health-Related Quality of Life (HRQoL)	Taiwan version of the 36-item Short Form Survey (SF-36). Score range 0-100, with higher score indicating better health outcomes.	6th month following hospital discharge
Health-Related Quality of Life (HRQoL)	Taiwan version of the 36-item Short Form Survey (SF-36). Score range 0-100, with higher score indicating better health outcomes.	12th month following hospital discharge
Health-Related Quality of Life (HRQoL)	Taiwan version of the 36-item Short Form Survey (SF-36). Score range 0-100, with higher score indicating better health outcomes.	18th month following hospital discharge
Health-Related Quality of Life (HRQoL)	Taiwan version of the 36-item Short Form Survey (SF-36). Score range 0-100, with higher score indicating better health outcomes.	24th month following hospital discharge
number of visits to emergency department	collected by assessor asking family members	3rd month following hospital discharge
number of visits to emergency department	collected by assessor asking family members	6th month following hospital discharge
number of visits to emergency department	collected by assessor asking family members	12th month following hospital discharge
number of visits to emergency department	collected by assessor asking family members	18th month following hospital discharge
number of visits to emergency department	collected by assessor asking family members	24th month following hospital discharge
number of hospital readmission	collected by assessor by asking family members	3rd month following hospital discharge
number of hospital readmission	collected by assessor by asking family members	6th month following hospital discharge
number of hospital readmission	collected by assessor by asking family members	12 month following hospital discharge
number of hospital readmission	collected by assessor by asking family members	18th month following hospital discharge
number of hospital readmission	collected by assessor by asking family members	24 month following hospital discharge

Collaborators and Investigators

• Sponsor: Chang Gung Memorial Hospital
• Collaborators: National Health Research Institutes, Taiwan; Chang Gung University
• Investigators: Principal Investigator: Yea-Ing Shyu, Chang Gung University

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): December 31, 2030
• Study Completion (Estimated): December 31, 2030

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 11, 2026
• First Posted (Actual): February 19, 2026

Study Record Updates

• Last Update Posted (Actual): February 19, 2026
• Last Update Submitted That Met QC Criteria: February 11, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: hip fracture; smart care; family caregiving; person-centered care; precision care
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Fractures, Bone; Femoral Fractures; Hip Injuries; Hip Fractures
• Other Study ID Numbers: NHRI-EX115-11506PI

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