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A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty

Murtagh, Fliss E.M.; Okoeki, Mabel; Ukoha-kalu, Blessing Onyinye; Khamis, Assem; Clark, Joseph; Boland, Jason W.; Pask, Sophie; Nwulu, Ugochinyere; Elliott-Button, Helene; Folwell, Anna; Harman, Daniel; Johnson, Miriam J.

Authors

Mabel Okoeki

Blessing Onyinye Ukoha-kalu

Assem Khamis

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Dr Jason Boland J.Boland@hull.ac.uk
Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine

Sophie Pask

Ugochinyere Nwulu

Helene Elliott-Button

Anna Folwell

Daniel Harman



Abstract

Background
Integrated care may improve outcomes for older people living with frailty. We aimed to assess the effectiveness of a new, anticipatory, multidisciplinary care service in improving the wellbeing and quality of life (QoL) of older people living with severe frailty.

Methods
A community-based non-randomised controlled study. Participants (≥65 years, electronic Frailty Index ≥0.36) received either the new integrated care service plus usual care, or usual care alone. Data collection was at three time points: baseline, 2-4 weeks, and 10-14 weeks. The primary outcome was patient wellbeing (symptoms and other concerns) at 2-4 weeks, measured using the Integrated Palliative care Outcome Scale (IPOS); the secondary outcome was QoL, measured using EQ-5D-5L. To test duration of effect and safety, wellbeing and QoL were also measured at 10-14 weeks. Descriptive statistics were used to characterise and compare intervention and control groups (eligible but had not accessed the new service), with t-test, Chi-Square, or Mann-Whitney U tests (as appropriate) to test differences at each time point. Generalised linear modelling, with propensity score matching, was used for further group comparisons. Data were analysed using STATA v17.

Results
199 intervention and 54 control participants were recruited. At baseline, intervention and control groups were similar in age, gender, ethnicity, living status, and body mass index, but not functional status or area deprivation score. At 2-4 weeks, wellbeing had improved in the intervention group but worsened in the control (median IPOS -5 versus 2, p<0.001). QoL improved in the intervention group but was unchanged in the control (median EQ-5D-5L 0.12, versus 0.00, p<0.001). After adjusting for age, gender, and living status, the intervention group had an average total IPOS score reduction at 2-4 weeks of 6.34 (95% CI: -9.01: -4.26, p<0.05); this improvement was sustained, with an average total IPOS score reduction at 10-14 weeks of 6.36 (95% CI: -8.91:-3.80, p<0.05). After propensity score matching based on functional status/area deprivation, modelling showed similar results, with a reduction in IPOS score at 2-4 weeks in the intervention group of 7.88 (95% CI: -12.80: -2.96, p<0.001).

Conclusions
Our findings suggest that the new, anticipatory, multidisciplinary care service may have improved the overall wellbeing and quality of life of older people living with frailty at 2-4 weeks and the improvement in wellbeing was sustained at three months.

Citation

Murtagh, F. E., Okoeki, M., Ukoha-kalu, B. O., Khamis, A., Clark, J., Boland, J. W., …Johnson, M. J. (2023). A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty. BMC Geriatrics, 23(1), Article 6. https://doi.org/10.1186/s12877-023-03727-2

Journal Article Type Article
Acceptance Date Jan 3, 2023
Online Publication Date Jan 5, 2023
Publication Date Jan 5, 2023
Deposit Date Jan 5, 2023
Publicly Available Date Mar 28, 2024
Journal BMC Geriatrics
Print ISSN 1471-2318
Electronic ISSN 1471-2318
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 23
Issue 1
Article Number 6
DOI https://doi.org/10.1186/s12877-023-03727-2
Keywords Older people; Frailty; Wellbeing; Multidisciplinary team; Integrated care; Quality of life; Proactive care
Public URL https://hull-repository.worktribe.com/output/4164468

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Copyright Statement
© The Author(s) 2023.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4. 0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.




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