A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty

Murtagh, Fliss E.M.; Okoeki, Mabel; Ukoha-kalu, Blessing Onyinye; Khamis, Assem; Clark, Joseph; Boland, Jason W.; Pask, Sophie; Nwulu, Ugochinyere; Elliott-Button, Helene; Folwell, Anna; Harman, Daniel; Johnson, Miriam J.

Abstract

Background
Integrated care may improve outcomes for older people living with frailty. We aimed to assess the effectiveness of a new, anticipatory, multidisciplinary care service in improving the wellbeing and quality of life (QoL) of older people living with severe frailty.

Methods
A community-based non-randomised controlled study. Participants (≥65 years, electronic Frailty Index ≥0.36) received either the new integrated care service plus usual care, or usual care alone. Data collection was at three time points: baseline, 2-4 weeks, and 10-14 weeks. The primary outcome was patient wellbeing (symptoms and other concerns) at 2-4 weeks, measured using the Integrated Palliative care Outcome Scale (IPOS); the secondary outcome was QoL, measured using EQ-5D-5L. To test duration of effect and safety, wellbeing and QoL were also measured at 10-14 weeks. Descriptive statistics were used to characterise and compare intervention and control groups (eligible but had not accessed the new service), with t-test, Chi-Square, or Mann-Whitney U tests (as appropriate) to test differences at each time point. Generalised linear modelling, with propensity score matching, was used for further group comparisons. Data were analysed using STATA v17.

Results
199 intervention and 54 control participants were recruited. At baseline, intervention and control groups were similar in age, gender, ethnicity, living status, and body mass index, but not functional status or area deprivation score. At 2-4 weeks, wellbeing had improved in the intervention group but worsened in the control (median IPOS -5 versus 2, p<0.001). QoL improved in the intervention group but was unchanged in the control (median EQ-5D-5L 0.12, versus 0.00, p<0.001). After adjusting for age, gender, and living status, the intervention group had an average total IPOS score reduction at 2-4 weeks of 6.34 (95% CI: -9.01: -4.26, p<0.05); this improvement was sustained, with an average total IPOS score reduction at 10-14 weeks of 6.36 (95% CI: -8.91:-3.80, p<0.05). After propensity score matching based on functional status/area deprivation, modelling showed similar results, with a reduction in IPOS score at 2-4 weeks in the intervention group of 7.88 (95% CI: -12.80: -2.96, p<0.001).

Conclusions
Our findings suggest that the new, anticipatory, multidisciplinary care service may have improved the overall wellbeing and quality of life of older people living with frailty at 2-4 weeks and the improvement in wellbeing was sustained at three months.

Citation

Murtagh, F. E., Okoeki, M., Ukoha-kalu, B. O., Khamis, A., Clark, J., Boland, J. W., Pask, S., Nwulu, U., Elliott-Button, H., Folwell, A., Harman, D., & Johnson, M. J. (2023). A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty. BMC Geriatrics, 23, Article 6. https://doi.org/10.1186/s12877-023-03727-2

• Journal Article Type: Article
• Acceptance Date: Jan 3, 2023
• Online Publication Date: Jan 5, 2023
• Publication Date: Jan 5, 2023
• Deposit Date: May 5, 2023
• Publicly Available Date: May 9, 2023
• Journal: BMC Geriatrics
• Electronic ISSN: 1471-2318
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 23
• Article Number: 6
• DOI: https://doi.org/10.1186/s12877-023-03727-2
• Keywords: Geriatrics and Gerontology
• Public URL: https://nottingham-repository.worktribe.com/output/20287174
• Publisher URL: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-03727-2
• Additional Information: Received: 22 July 2022; Accepted: 3 January 2023; First Online: 5 January 2023; : ; : This study obtained full ethical approvals: Integrated Research and Approval System (IRAS) -250981, and National Health Service Research Ethics Committee (NHS REC) - 18/YH/0470 before commencement. We ensured that each participant received written informed consent, understood its contents, and then accepted to take part in the study before having them sign it. We confirm that all methods were performed in accordance with the guidelines of the Declaration of Helsinki.; : Not applicable; : The authors declare that they have no competing interests