Protocol of a case-control longitudinal study (fraXity) assessing frailty and complexity among Swiss home service recipients using interRAI-HC assessments

Catherine Ludwig, Catherine Busnel, Catherine Ludwig, Catherine Busnel

Abstract

Background: The early screening of frail individuals and of patients with complex care needs are challenges that countries witnessing population aging face. Homecare nurses are actors of choice in meeting these challenges, yet they need means of identifying frail and complex patients in their routine practice. The fraXity study's aim is to fill this gap by (1) proposing frailty and complexity computation algorithms derived from the interRAI-HC; (2) assessing the predictive validity of the proposed indices with respect to adverse health outcomes; and (3) identifying subgroups of the aged population for whom the early screening of frailty and complexity appears to be most relevant.

Methods: The study will rely on a prospective observational case-control longitudinal study. Three samples of individuals aged 65 or older living in the community will be considered: recipients of formal home care (case 1), of formal home assistance (case 2) and individuals free of formal home services (controls). All participants will receive interRAI-HC assessments at three measurement occasions, separated by six-month intervals. Baseline assessments will serve to derive frailty and complexity scores. Follow-ups will serve to assess the predictive validity of the proposed indices and to estimate the intra-individual change in frailty and complexity. Group comparisons will serve to identify subgroups of the population for whom the screening of frailty and complexity appears to be the most relevant.

Discussion: The expected results of the fraXity study are a) reliable computation algorithms for frailty and complexity scores derived from the interRAI-HC and b) clinical assessment protocols for use by homecare nurses. These outcomes should contribute to outfitting key actors of the health system with means of enhancing their part in a collective endeavor targeting the best care and quality of life for aged citizens.

Trial registration: ClinicalTrials.gov, NCT03883425 , registered on March 20, 2019.

Keywords: Complexity; Frailty; Home care; Nursing; Standardized geriatric assessment.

Conflict of interest statement

The authors declare that they have no competing interests. Relevant to this statement is a clarification regarding the involvement of imad in the study. Imad is domiciled in Canton Geneva, Switzerland; it is a public autonomous institution that operates under the supervision of the State Council of Canton, Geneva. Cantonal (LIMAD - k1 07, LSDOM - k1 06 and RSDom k1 06.01) and federal laws (LAMal) regulate imad. Its basic financing is predominantly Swiss and public. Projects conducted at imad are non-commercial and of public interest. Also relevant is the fact that the interRAI RAI-HC instrument is used for research purposes, royalty free. Thus, no conflict of interest with the interRAI Consortium exists.

Figures

Fig. 1
Fig. 1
Flow chart summarizing the general procedure of the fraXity study

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