Abstract
Introduction
Integrated care potentially improves coordination and health outcomes for older people with frailty. We aimed to assess the effectiveness of a new, proactive, multidisciplinary care service in improving the well-being and quality of life of older people with frailty.
Methods
A community-based non-randomised controlled trial. 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 3-time points: baseline, 2-4 weeks, and 10-14 weeks; the primary outcome was patient well-being at 2-4 weeks, measured using the Integrated Palliative care Outcome Scale, IPOS. The secondary outcome was quality of life, measured using EQ-5D-5L. Well-being and quality of life at 10-14 weeks were measured to test safety and duration of effect. Data were analysed with STATA v17.
Results
199 intervention and 54 control participants were recruited. At baseline, participants were similar in age, gender, body mass index, ethnicity, and living status. At 2-4 weeks, the intervention group had improved well-being (median IPOS reduction 5, versus control group increase 2, p<0.001) and improved quality of life (median EQ-5D index values increase 0.12 versus control 0.00, p<0.001); these were clinically significant. After adjusting for age, gender and living status, the intervention group had an average total IPOS score reduction of 6.34 (95% CI: -9.01: -4.26, p<0.05). Propensity score matching analysis based on functional status and deprivation score showed similar results (reduction in IPOS score in intervention group 7.88 (95% CI: -12.80: -2.96, p<0.001). At 10-14 weeks, the intervention group sustained well-being improvement (median IPOS score reduction of 4, versus control increase of 2, p<0.001) and improved quality of life (median EQ-5D index values increase 0.06 versus control -0.01, p<0.001).
Conclusion
The new integrated care service improves the overall well-being and quality of life of older people with frailty at 2-4 weeks; improvement was sustained at 3 months.
Ethics Approval
IRAS-250981 and NHS Research Ethics Committee 18/YH/0470