Westgård Theresa, Ottenvall Hammar Isabelle, Holmgren Eva, Ehrenberg Anna, Wisten Aase, Ekdahl Anne W, Dahlin-Ivanoff Synneve, Wilhelmson Katarina
1Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, House 2, Box 455, 405 30 Gothenburg, Sweden.
3Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden.
Pilot Feasibility Stud. 2018 Jan 29;4:41. doi: 10.1186/s40814-018-0228-1. eCollection 2018.
Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.
The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.
Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].
The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.
Clinical Trials ID: NCT02773914. Registered 16 May 2016.
综合老年医学评估（CGA）是老年急性医院护理中针对体弱老年人的重要组成部分，由多学科团队提供，该团队可满足老年人在身体健康、功能能力、心理状态、认知和社会地位等多方面的需求。该试点研究的主要目的是确定招募和保留率的可行性。次要目的是确立CGA有可能提高患者安全性的原理证明。
CGA试点于2016年3月至11月在瑞典西部的一家大学医院进行，并于2017年3月进行数据分析。参与者为75岁及以上需要急性入院治疗的体弱老年人。参与者在急诊室被招募并随机分组。干预组接受CGA，即由一个以人为本的多学科团队负责健康、参与和安全。对照组接受常规护理。主要目标衡量招募程序和保留率。还收集了关于在病房接受的服务的次要目标，包括出院计划、护理计划会议以及医院风险评估，如跌倒风险、营养、压疮和日常生活状况。
在32周内从急诊科招募了参与者。共接触了30名参与者，100%（30/30）被纳入并随机分组，且100%（30/30）符合纳入标准。16名参与者被纳入干预组，14名参与者被纳入对照组。在基线时，100%（16/16）的干预组和100%（14/14）的对照组完成了数据收集。干预组在次要目标方面也显示出积极倾向，因为该组接受了更多护理评估。干预组和对照组在职业治疗评估方面平均差异为-0.80 [95% CI 1.06, -0.57]，职业治疗辅助设备方面为-0.73 [95% CI 1.00, -0.47]，出院计划方面为-0.21 [95% CI 0.43, 0.00]，护理计划会议方面为0.36 [95% CI -1.70, -0.02]。在控制记录的风险评估后，干预组在跌倒方面为-0.94 [95% CI 1.08, -0.08]，营养方面为-0.87 [95% CI 1.06, -0.67]，压疮方面为-0.94 [95% CI 1.08, -0.80]，日常生活活动状况方面为-0.80 [95% CI 1.04, -0.57]。
CGA试点是可行的，且干预措施提高安全性的原理证明为开展大规模研究提供了依据。
临床试验标识号：NCT02773914。于2016年5月16日注册。
