Patient-outcomes of a frailty management program for community-dwelling older adults in Singapore: A cohort evaluation - 23/04/25
, Robin Choo 1, Grace Sum 1, Goh Siew Fong 1, Ding Yew Yoong 1, 2, 3, Lim Wee Shiong 1, 2, Tan Woan Shin 1Geriatric Service Hub Programme Group#
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Abstract |
Background |
There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.
Objectives |
We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.
Design |
Single-arm pre-post design.
Setting |
Community-based health and social care provider
Participants |
218 GSH patients, aged≥65, with CFS4 to CFS7.
Intervention |
Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.
Measurements |
Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.
Results |
We studied 191 (87.6%) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (Mdiff=-0.2, 95%CI[-1.8;1.3]) and 6-months (Mdiff=-0.5, 95%CI[-2.2;1.2]). Patient activation increased slightly at 3-months (Mdiff=3.0, 95%CI[0.1;5.9]) but not at 6-months (Mdiff=1.5, 95%CI[-1.2;4.1]). There were significant increases for health-related QoL at 3-months (Mdiff=0.068, 95%CI[0.041;0.095]) and 6-months (Mdiff=0.045, 95%CI[0.016;0.074]), and for emotional-related QoL at 3-months (Mdiff=2.3, 95%CI[1.2;3.3]) and 6-months (Mdiff=1.5, 95%CI[0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6-7.
Conclusions |
Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. Sub-group analyses suggest that GSH is beneficial for patients categorised as CFS4 and CFS5, but the programme played a largely maintenance role for patients with CFS6-7.
Le texte complet de cet article est disponible en PDF.Keywords : Comprehensive Geriatric Assessment, functional status, quality-of-life, patient activation, clinical frailty scale (CFS)
Plan
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