Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization

Abstract

Background: Multimorbidity and frailty are often associated and Comprehensive Geriatric Assessment (CGA) is considered the gold standard of care for these patients.

Aims: This study aimed to evaluate the effect of outpatient Comprehensive Geriatric Assessment (CGA) on frailty in community-dwelling older people with multimorbidity and high health care utilization.

Methods: The Ambulatory Geriatric Assessment-Frailty Intervention Trial (AGe-FIT) was a randomized controlled trial (intervention group, n = 208, control group n = 174) with a follow-up period of 24 months. Frailty was a secondary outcome. Inclusion criteria were: age ≥ 75 years, ≥ 3 current diagnoses per ICD-10, and ≥ 3 inpatient admissions during 12 months prior to study inclusion. The intervention group received CGA-based care and tailored interventions by a multidisciplinary team in an Ambulatory Geriatric Unit, in addition to usual care. The control group received usual care. Frailty was measured with the Cardiovascular Health Study (CHS) criteria. At 24 months, frail and deceased participants were combined in the analysis.

Results: Ninety percent of the population were frail or pre-frail at baseline. After 24 months, there was a significant smaller proportion of frail and deceased (p = 0.002) and a significant higher proportion of pre-frail patients in the intervention group (p = 0.004). Mortality was high, 18% in the intervention group and 26% in the control group.

Conclusion: Outpatient CGA may delay the progression of frailty and may contribute to the improvement of frail patients in older persons with multimorbidity.

Keywords: Community dwelling; Comprehensive Geriatric Assessment; Frailty; Multimorbidity; Outpatient; Randomized controlled trial.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethical Review Board in Linköping, Sweden (Dnr. 2011/41-31) and is registered at clinicaltrials.gov (NCT01446757).

Informed consent

All participants provided written informed consent prior to baseline assessment.

Figures

Fig. 1

Flowchart of participant selection, frailty assessment and missing data on frailty.*Community dwelling, ≥ 75 years, having received inpatient hospital care ≥ three times during the past 12 months and having ≥ three concomitant medical diagnoses identified from a population-based, administrative database. †Population-based, administrative database run by the County Council. ‡After three phone calls, no further attempts to reach the participants in baseline

Fig. 2

Frailty distributions at baseline and 24 months presented as proportions. At 24 months frail and deceased participants were combined to minimize mortality bias. There was a significant difference between the intervention group and the control group in the distribution of outcomes at 24 months. The proportion of pre-frail participants were larger in the IG (p = 0.004) and the proportion of frail and deceased participants were smaller (p = 0.002)

Fig. 3

The change in frailty status over 24-months in percent according to baseline status. The figure includes deceased participants and missing data