Naughton Corina, de Foubert Marguerite, Cummins Helen, McCullagh Ruth, Wills Teresa, Skelton Dawn A, Dahly Darren, O'Mahony Denis, Ahern Emer, Tedesco Salvatore, Sullivan Bridie O
School of Nursing, Midwifery, University College Cork, Cork, Ireland.
School of Clinical Therapies, University College Cork, Cork, Ireland.
J Frailty Sarcopenia Falls. 2024 Mar 1;9(1):32-50. doi: 10.22540/JFSF-09-032. eCollection 2024 Mar.
To implement and evaluate a Frailty Care Bundle (FCB) targeting mobilisation, nutrition, and cognition in older trauma patients to reduce hospital associated decline.
We used a two group, pretest-posttest design. The FCB intervention was delivered on two orthopaedic wards and two rehabilitation wards, guided by behaviour change theory (COM-B) to implement changes in ward routines (patient mobility goals, nurse assisted mobilisation, mealtimes, communication). Primary outcomes were patient participants' return to pre-trauma functional capability (modified Barthel Index - mBI) at 6-8 weeks post-hospital discharge and average hospital daily step-count. Statistical analysis compared pre versus post FCB group differences using ordinal regression and log-linear models.
We recruited 120 patients (pre n=60 and post n=60), and 74 (pre n=43, post n=36) were retained at follow-up. Median age was 78 years and 83% were female. There was a non-significant trend for higher mBI scores (improved function) in the post compared to pre FCB group (OR 2.29, 95% CI 0.98-5.36), associated with an average 11% increase in step-count.
It was feasible, during the Covid-19 pandemic, for multidisciplinary teams to implement elements of the FCB. Clinical facilitation supported teams to prioritise fundamental care above competing demands, but sustainability requires ongoing attention. ISRCTN registry: ISRCTN15145850 (https://doi.org/10.1186/ISRCTN15145850).
实施并评估一项针对老年创伤患者活动能力、营养状况和认知功能的衰弱护理包（FCB），以减少与医院相关的功能衰退。
我们采用两组前后测设计。FCB干预在两个骨科病房和两个康复病房实施，以行为改变理论（COM-B）为指导，对病房常规（患者活动目标、护士协助活动、用餐时间、沟通）进行改变。主要结局为患者出院后6至8周恢复到创伤前功能能力（改良巴氏指数 - mBI）以及平均每日医院步数。统计分析使用序数回归和对数线性模型比较FCB组干预前后的差异。
我们招募了120名患者（干预前n = 60，干预后n = 60），随访时保留了74名（干预前n = 43，干预后n = 36）。中位年龄为78岁，83%为女性。与FCB干预前组相比，干预后mBI评分有升高（功能改善）的非显著趋势（优势比2.29，95%置信区间0.98 - 5.36），平均步数增加了11%。
在新冠疫情期间，多学科团队实施FCB的各项要素是可行的。临床促进支持团队在相互竞争的需求中优先考虑基本护理，但可持续性需要持续关注。国际标准随机对照试验编号注册库：ISRCTN15145850（https://doi.org/10.1186/ISRCTN15145850）。
