Home-visits From geRiatric tEam aFter hIp fracTure

Frailty Clinical Trial

— REFIT  

Official title:

The Effect of Home-visit Follow-up With a Multidisciplinary Geriatric Team in Old Patients With a Hip Fracture

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04777136
• Other study ID #: HgH_UGT_01
• Status: Active, not recruiting
• Phase: N/A
• Start date: March 1, 2021
• Est. completion date: February 28, 2023

Study information

• Verified date: May 2022
• Source: Herlev Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The primary objective is to examine the effect of multidisciplinary geriatric team home-visits as follow-up after a hip fracture in old patients. The hypothesis is that home-visits will reduce the number of falls, readmissions, prevent functional decline, optimize that medical treatment, and a higher degree of satisfaction and quality of life.

Description:

Among older individuals, falling is a strong predictor of frailty, morbidity, and mortality and may cause a fracture. Many older patients experience recurrent falls, further functional decline, and readmission within the first three months. Hence, fall-related visits to the hospital represent a "red flag" but are also an opportunity for targeted intervention and prevention of future falls. However, many older patients are only treated for fall-related injuries and discharged without fall risk assessment or evaluation, hence there is a need for follow-up with targeted fall assessment and intervention to prevent further falls.

Thus, the present project aims to examine the effect of home-visit follow-up of older frail patients discharged from the orthopedic ward with a hip fracture. Furthermore, we will explore the effect of a cross-sectorial collaboration between hospital and municipality in the patients' homes to prevent falls, readmissions, medicine-associated adverse effects, and physical deconditioning in old frail patients.

The present study is a interventional trial. The intervention will consist of a home visit within ten weekdays of the discharge, where a comprehensive geriatric assessment (CGA) will be performed. The team performing the CGA consist of a Geriatrician and an experienced geriatric nurse. CGA is an overall assessment of the patient taking account of; the presence and severity of comorbidity, the nutritional state, cognitive and functional status, review of current medications, and social measures. The purpose is to stabilize and optimize current as well as chronic conditions, and reduce the probability of adverse events and falls, and to secure interventions or changes persist through the transition from the secondary to the primary health care system. The assessment may lead to several interventions, including; medicine review (new medicine, change in current or discontinuation), initiation of a nutritional effort or contact to a dietitian, referral to other health care services (outpatient clinics, hospitals, or general practitioner), referral to physiotherapy and/or occupational therapy or optimization of home care.

Patients randomized to the control group will receive standard care, where the subsequent need for medical service or increased home care will require contact with the general practitioner or the municipality, at the patient's initiative.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 200
• Est. completion date: February 28, 2023
• Est. primary completion date: April 1, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 70 Years to 120 Years

Eligibility

Inclusion Criteria:

• Age of 70 years or older

• Hip fracture

• Ability to provide informed consent

• Residence in one of three following municipalities: Gladsaxe, Rudersdal or Lyngby-Taarbæk

Exclusion Criteria:

• No ability to provide informed consent

• Patients, who dies within 48 hours of discharge

• Terminal patients

Nursing home residents

Related Conditions & MeSH terms

• Fractures, Bone
• Frailty
• Geriatric Assessment
• Hip Fractures
• Old Age; Atrophy

Intervention

Other:
• Home visit and comprehensive geriatric assessment
Home-visit from the geriatric team, who will do a full geriatric assessment and targeted interventions
• Control group, no designated follow up
Only follow-up on patients own initiative with contact to the general practitioner

Locations

Country	Name	City	State
Denmark	Herlev and Gentofte hospital	Herlev	Capital Region

Sponsors (1)

Lead Sponsor	Collaborator
Herlev Hospital

Country where clinical trial is conducted

Denmark, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Time to contact to the general practitioner or hospital because of a fall	Fall-related contact for treatment or assessment	90 days
Secondary	Contacts to a doctor	Number of contacts to a doctor (either hospital or the general practitioner)	90 days
Secondary	Contacts to a doctor	Number of contacts to a doctor (either hospital or the general practitioner)	30 days
Secondary	Falls	number of falls	30 days
Secondary	Falls	number of falls	90 days
Secondary	Preventable readmissions	Number of readmission deemed preventable by two blinded assessors	30 days
Secondary	Number of drugs	Number of inappropriate drugs (Stop/Startt criteria)	30 days
Secondary	Quality of life	Assessment of Quality of life using questionnaire (EQ VAS 0-100)	90 days
Secondary	Patient satisfaction and fear of falling	Assessment patient satisfaction using questionnaire (Sat-UG-1)	30 days
Secondary	Patient satisfaction and fear of faling	Assessment patient satisfaction using questionnaire (Sat-UG-1)	90 days
Secondary	All cause mortaliy	Mortality	30 days
Secondary	All cause mortaliy	Mortality	90 days
Secondary	Muscle strength	Measured using "timed-up-and-go" test	90 days
Secondary	Mobility	Assessed using the "new mobility score" (0-10, high is good)	90 days
Secondary	Mobility	Assessed using the "Cumulated Ambulation Score" (0-6, high is good)	90 days
Secondary	Weight	Change in weight i kilograms from discharge "Cumulated Ambulation Score", and "new mobility score"	90 days
Secondary	Independence	Number of patients using walking aids	90 days
Secondary	Independence	Number of patients with a new placement at a nursing homes	90 days