College of Health, Psychology and Social Care, University of Derby, Kedleston Rd, Derby, DE22 1GB, Derbyshire, UK.
BMC Geriatr. 2023 Aug 24;23(1):513. doi: 10.1186/s12877-023-04218-0.
Comprehensive Geriatric Assessment (CGA)is a widely accepted intervention for frailty and can be cost-effective within a primary care setting.
To explore the feasibility of identifying older adults with frailty and assess the subsequent implementation of a tailored CGA with care and support plan by Advanced Nursing Practitioners (ANPs).
A mixed-method parallel randomised controlled trial was conducted. Participants were recruited from two General Practice (GP) centres between January and June 2019. Older adults with confirmed frailty, as assessed by practice nurses, were randomised, using a web service, to the intervention or treatment-as-usual (TAU) groups for six months with an interim and a final review. Data were collected on feasibility, health service usage, function, quality of life, loneliness, and participants' experience and perception of the intervention. Non-parametric tests were used to analyse within and between-group differences. P-values were adjusted to account for type I error. Thematic analysis of qualitative data was conducted.
One hundred sixty four older adults were invited to participate, of which 44.5% (n = 72) were randomised to either the TAU (n = 37) or intervention (n = 35) groups. All participants in the intervention group were given the baseline, interim and final reviews. Eight participants in each group were lost to post-intervention outcome assessment. The health service use (i.e. hospital admissions, GP/emergency calls and GP/Accident Emergency attendance) was slightly higher in the TAU group; however, none of the outcome data showed statistical significance between-group differences. The TAU group showed a deterioration in the total functional independence and its motor and cognition components post-intervention (p < .05), though the role limitation due to physical function and pain outcomes improved (p < .05). The qualitative findings indicate that participants appreciated the consistency of care provided by ANPs, experienced positive therapeutic relationship and were connected to wider services.
Frailty identification and intervention delivery in the community by ANPs were feasible. The study shows that older adults with frailty living in the community might benefit from intervention delivered by ANPs. It is suggested to examine the cost-effectiveness of the intervention in sufficiently powered future research.
The protocol is available at clinicaltirals.gov, ID: NCT03394534; 09/01/2018.
综合老年评估（CGA）是一种广泛接受的衰弱干预措施，在初级保健环境中具有成本效益。
探索通过高级护理从业者（ANP）识别衰弱老年人并评估随后制定量身定制的 CGA 以及护理和支持计划的可行性。
进行了一项混合方法平行随机对照试验。参与者于 2019 年 1 月至 6 月期间从两家全科医疗（GP）中心招募。经过实践护士评估，确认患有衰弱的老年人使用网络服务随机分配到干预组或常规治疗组（TAU），为期六个月，进行中期和最终评估。收集了可行性、卫生服务使用、功能、生活质量、孤独感以及参与者对干预措施的体验和看法方面的数据。使用非参数检验分析组内和组间差异。p 值调整以考虑 I 型错误。对定性数据进行主题分析。
邀请了 164 名老年人参加，其中 44.5%（n=72）随机分配到 TAU（n=37）或干预组（n=35）。干预组的所有参与者都接受了基线、中期和最终评估。每组有 8 名参与者在干预后失去了结果评估。TAU 组的卫生服务使用（即住院、全科医生/紧急电话和全科医生/事故急诊就诊）略高；然而，组间差异的结果数据均无统计学意义。干预后 TAU 组的总功能独立性及其运动和认知成分恶化（p<.05），但身体功能和疼痛结果导致的角色限制改善（p<.05）。定性研究结果表明，参与者对 ANP 提供的护理一致性表示赞赏，体验到积极的治疗关系，并与更广泛的服务建立了联系。
由 ANP 在社区中进行衰弱识别和干预是可行的。该研究表明，生活在社区中的衰弱老年人可能受益于 ANP 提供的干预措施。建议在未来的研究中，通过足够大的样本量检验干预措施的成本效益。
该方案可在 clinicaltrials.gov 上获取，编号：NCT03394534；2018 年 9 月 1 日。
