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.
Balance quality assessment as an early indicator of physical frailty in older peopleChkeir, Aly; Safieddine, Doha; Bera, Delphine; Collart, Michèle; Novella, Jean-Luc; Drame, M.; Hewson, David; Duchêne, Jacques (IEEE, 2016-10-01)Frailty is an increasingly common geriatric condition that results in an increased risk of adverse health outcomes such as falls. The most widely-used means of detecting frailty is the Fried phenotype, which includes several objective measures such as grip strength and gait velocity. One method of screening for falls is to measure balance, which can be done by a range of techniques including the assessment of the Centre of Pressure (CoP) during a balance assessment. The Balance Quality Tester (BQT) is a device based on a commercial bathroom scale that can evaluate balance quality. The BQT provides instantaneously the position of the CoP (stabilogram) in both anteroposterior (AP) and mediolateral (ML) directions and can estimate the vertical ground reaction force. The purpose of this study was to examine the relationship between balance quality assessment and physical frailty. Balance quality was compared to physical frailty in 186 older subjects. Rising rate (RR) was slower and trajectory velocity (TV) was higher in subjects classified as frail for both grip strength and gait velocity (p<;0.05). Balance assessment could be used in conjunction with functional tests of grip strength and gait velocity as a means of screening for frailty.