Effectiveness of integrated chronic care interventions for older people with different frailty levels: a systematic review protocol
AffiliationUniversity of Bedfordshire
Subjectsintegrated care service
Subject Categories::B741 Geriatric Nursing
MetadataShow full item record
AbstractINTRODUCTION: Frailty poses a huge burden to individuals, their families and to healthcare systems. Several interventions have been evaluated for the improvement of outcomes for older people with frailty, including integrated care interventions. Reviews synthesising evidence on the effectiveness of integrated care for older people with frailty have treated them as a single population, without considering the heterogeneity between different frailty levels such as non-frail, mild frailty, moderate frailty and severe frailty. Findings from these studies have shown inconsistent results on the various outcomes assessed. People with different frailty status have different care needs, which should be addressed accordingly. The aim of this study is to synthesise evidence on the effectiveness of integrated care interventions on older people with different frailty status who are community dwelling or living in retirement housing or residential setting but not in care homes or in nursing homes. METHODS AND ANALYSIS: This is a protocol for a systematic review assessing the effectiveness of integrated chronic care interventions on older people with different frailty status. A literature search will be conducted on the databases Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and clinical trial registers. Two authors will independently conduct search and screening for eligible studies. Full-text screening will be used to include only studies that fulfil the inclusion criteria. Data extraction will be done on a data extraction form and methodological quality of studies will be assessed using the Effective Practice and Organisation of Care risk of bias tool. The interventions will be described following Wagner's Chronic Care Model. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Institute for Health Research Ethics Committee of the University of Bedfordshire (IHREC934). The results of the review will be disseminated through a peer-reviewed journal article, conferences and also with local provider and user stakeholders. PROSPERO REGISTRATION NUMBER: CRD42020166908.
CitationKhan N, Hewson D, Randhawa G (2020) 'Effectiveness of integrated chronic care interventions for older people with different frailty levels: a systematic review protocol', BMJ Open, 10 (9)
PubMed Central IDPMC7485241
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Is there a relationship between frailty indices and balance assessment in older people?Chkeir, Aly; Safieddine, Doha; Chehade, F.; Duchêne, Jacques; Hewson, David; Bera, Delphine; Collart, Michèle; Novella, Jean-Luc; Drame, M. (IEEE, 2016-11-21)Grip-strength, walking speed and weight-loss are key measurements in the evaluation of frailty. According to L. Fried, these quantities are compared with thresholds, leading to associated frailty indices that would afterwards be combined to establish an overall decision. One of the consequences of frailty is an increasing risk of falls, which are a major cause of death of older people. The purpose of this study is to examine the possible relationships that could exist between grip-strength, walking speed, weight-loss and other parameters extracted from balance quality assessment for older subjects. The study shows that a relationship does exist between the balance quality parameters and the frailty indices.
Ethnic differences in the prevalence of frailty in the United Kingdom assessed using the electronic Frailty IndexPradhananga, Shraddha; Regmi, Krishna; Razzaq, Nasrin; Ettefaghian, Alireza; Dey, Aparajit Ballav; Hewson, David (Wiley, 2019-09-13)Objective: There have been few studies in which the prevalence of frailty of different ethnic groups has been assessed in multiethnic countries. The aim of this study was to evaluate the prevalence of frailty in different ethnic groups in the United Kingdom. Methods: Anonymized electronic health records (EHR) of 13 510 people aged 65 years and over were extracted from the database of a network of general practitioners, covering 16 clinical commissioning groups in London. Frailty was determined using the electronic Frailty Index (eFI), which was automatically calculated using EHR data. The eFI was used as a categorical variable with fit and mild frailty grouped together, and moderate and severe frailty grouped as frail. Results: The overall prevalence of frailty was 18.1% (95% confidence interval [CI], 17.4%‐18.9%). The prevalence of frailty increased with age (odds ratio [OR], 1.11; 95% CI, 1.10‐1.12) and body mass index (BMI; OR, 1.05; 95% CI, 1.04‐1.06). The highest prevalence of frailty was observed for Bangladeshis, with 32.9% classified as frail (95% CI, 29.2‐36.7); and the lowest prevalence of 14.0% (95% CI, 12.6‐15.5) was observed for the Black ethnic group. Stepwise logistic regression retained ethnicity, age, and BMI as predictors of frailty. Conclusion: This pilot study identified differences in the prevalence of frailty between ethnic groups in a sample of older people living in London. Additional studies are warranted to determine the causes of such differences, including migration and socioeconomic status. It would be worthwhile carrying out a validation study of the eFI in different ethnic populations.
An evaluation of the Luton Framework for Frailty: an integrated care programme for older People with different frailty levelsKhan, Nimra Naeem (University of BedfordshireUniversity of Bedfordshire, 2023-07)Background: Frailty is an age-associated condition in which a person loses reserves due to accumulation of multiple deficits making an individual vulnerable to minor stress and it leads to adverse outcomes such as falls, fractures, emergency hospital admission, institutionalisation and mortality. Frailty is posing a burden to the NHS and to social care in the UK. The NHS in England has made identifying and managing those people with moderate or severe frailty at the general practice level mandatory as part of the GMS 2017/18 contract. The Luton Clinical Commissioning Group (Luton CCG) has used these policy recommendations to develop the Luton Framework for Frailty (LFF). The LFF is an integrated care programme, which is offered to older people aged ≥65 years who are residents of Luton. Initially, an older person is assessed for frailty using the eFI and clinical judgement at their general practice, an individual is categorised according to their frailty level into one of the four categories of fit, mild, moderate and severe frailty, with services offered according to frailty level. It has been nearly three years since this policy has been introduced and the LFF has been implemented. However, no comprehensive evaluation has been conducted yet. The present study was commissioned to gain a deeper understanding of the LFF and the factors that affect the implementation of an integrated care programme and its impact on the outcomes for older people with different frailty levels (OPDFL). Methods: This study has used a mixed-methods approach. A systematic review was conducted to assess the effectiveness of integrated care interventions on OPDFL. A qualitative study was conducted with service providers including commissioners, programme managers, general practitioners and geriatricians to process map the care pathways for OPDFL in Luton and to: firstly, explore their perceptions regarding the barriers and facilitators to the implementation of LFF, secondly describe the LFF according to the six domains of the chronic care model and explore its strengths and limitations and thirdly, explore their perceptions of the impact COVID-19 had on the implementation of LFF. Finally, a quantitative study was conducted to analyse the routinely collected patient data to assess the impact of LFF on the outcomes such as falls reported to the general practice, emergency hospital visits and deaths for OPDFL. Results: The findings of the review show there is a lack of studies that have assessed the effectiveness of integrated care interventions for older people stratified by their frailty levels. 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Furthermore, it was found that COVID-19 had negatively impacted all the preventative work started through LFF which was halted during the pandemic. The quantitative study showed that the routinely collected data are of questionable quality due to the huge numbers of missing values. There is huge variation in the services provided to OPDFL, while some practices provide services to a higher number of individuals, others provide services to a very low number. The number of falls reported to the general practice was very few throughout the forty-one months period reported in this study, emergency hospital admissions were higher while the number of deaths reported had errors. Finally, while the services provided increased in the first few months of LFF, they then reduced again. Contributions to Knowledge: This is the first comprehensive evaluation of the implementation of the national policy of identifying and managing older people with frailty at a local level. Evidence generated by this study provides guidance to commissioners, service providers and policymakers for areas of improvement and implementation of a system-wide integrated care intervention for OPDFL and the limitations identified in this study can guide future research.