Optimizing Prevention of Hospital-Acquired Disability Through Multidomain Interventions

Launched by UNIVERSITY OF MILANO BICOCCA · Sep 20, 2024

Keywords

ClinConnect Summary

This clinical trial is looking at how a special program, which combines different types of care and technology, can help older patients in the hospital who are at risk of becoming more frail or disabled. The goal is to see if this program can improve their ability to function and think clearly, both while they’re in the hospital and after they go home. Participants will either receive this program during their hospital stay and get support at home for three months, or they will receive the usual care.

To join the trial, participants need to be over 70 years old and have mild to moderate frailty, meaning they might need some help with daily activities but can still walk with or without assistance. They will have follow-up appointments at three and six months after their hospital stay to check on their progress. Overall, this study aims to find out if a more connected and comprehensive approach can make a difference for older patients during and after their hospital experience.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Age \>70 years;
• • Mild to moderate frailty, defined by a panel of tools agreed upon by the group of researchers involved in the study (Primary Care Frailty Index \[PC-FI\] between 0.07 and 0.21, Clinical Frailty Scale \[CFS\] 4-6);
• • Ability to walk with or without assistance
• • Ability to communicate and cooperate with the research team;
• • Ability to sign informed consent.
• Exclusion Criteria:
• • Expected hospital stay duration \<3 days;
• • Estimated prognosis quoad vitam \<12 months;
• • Persistent clinical instability, indicated by a NEWS2 score \>5 (assessed within 48 hours of admission) and/or the presence of delirium (4AT \>4);
• • History of schizophrenia, major depression, bipolar disorder, or psychosis;
• • Severe sensory deficits (visual and auditory);
• • Presence of a nasogastric tube or percutaneous endoscopic gastrostomy (PEG);
• • Severe cardiac conduction disorder (e.g., third-degree atrioventricular block), uncontrolled arrhythmia, new Q wave in the past six months, or ST segment depression (\>3 mm) on the electrocardiogram;
• • Terminal stage oncological or organic disease (e.g., Child-Pugh C cirrhosis, stage V renal disease, GOLD stage D chronic obstructive pulmonary disease, end-stage heart failure);
• • Residence in a nursing home before hospital admission;
• • Presence of dissected aortic aneurysm, severe aortic stenosis, acute endocarditis/pericarditis, acute thromboembolism, uncontrolled hypertension (\>180/100 mmHg) or postural hypotension, uncontrolled hypoglycemia, recent fracture within the last month, or any other medical condition that hinders the execution of physical activity according to clinical judgment;
• • Any condition that prevents safe participation in the intervention and/or cooperation with the study;
• • Concurrent participation in other clinical studies;
• • Clinical conditions or situations significantly different from the condition under study, which in the investigator's opinion could interfere with the study or prevent optimal participation;
• • Participants refusal to participate in the study.