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IT-assisted comprehensive geriatric assessment for residents in care homes: Quasiexperimental longitudinal study

Attwood, David; Vafidis, Jim; Boorer, James; Long, Scarlett; Ellis, Wendy; Earley, Michelle; Denovan, Jillian; Hart, Gerard ’t; Williams, Maria; Burdett, Nicholas; Lemon, Melissa; Hope, Suzy

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Authors

David Attwood David.Attwood@uwe.ac.uk
Associate Professor in Biosensing Systems

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Jim Vafidis Jim.Vafidis@uwe.ac.uk
Senior Lecturer in Conservation Science

James Boorer

Scarlett Long

Wendy Ellis

Michelle Earley

Jillian Denovan

Gerard ’t Hart

Maria Williams

Nicholas Burdett

Melissa Lemon

Suzy Hope



Abstract

Background: Frailty interventions such as Comprehensive Geriatric Assessment (CGA) can provide significant benefits for older adults living with frailty. However, incorporating such proactive interventions into primary care remains a challenge. We developed an IT-assisted CGA (i-CGA) process, which includes advance care planning (ACP). We assessed if, in older care home residents, particularly those with severe frailty, i-CGA could improve access to advance care planning discussions and reduce unplanned hospitalisations. Method: As a quality improvement project we progressively incorporated our i-CGA process into routine primary care for older care home residents, and used a quasi-experimental approach to assess its interim impact. Residents were assessed for frailty by General Practitioners. Proactive i-CGAs were completed, including consideration of traditional CGA domains, deprescribing and ACP discussions. Interim analysis was conducted at 1 year: documented completion, preferences and adherence to ACPs, unplanned hospital admissions, and mortality rates were compared for i-CGA and control (usual care) groups, 1-year post-i-CGA or post-frailty diagnosis respectively. Documented ACP preferences and place of death were compared using the Chi-Square Test. Unplanned hospital admissions and bed days were analysed using the Mann-Whitney U test. Survival was estimated using Kaplan-Meier survival curves. Results: At one year, the i-CGA group comprised 196 residents (severe frailty 111, 57%); the control group 100 (severe frailty 56, 56%). ACP was documented in 100% of the i-CGA group, vs. 72% of control group, p < 0.0001. 85% (94/111) of severely frail i-CGA residents preferred not to be hospitalised if they became acutely unwell. For those with severe frailty, mean unplanned admissions in the control (usual care) group increased from 0.87 (95% confidence interval ± 0.25) per person year alive to 2.05 ± 1.37, while in the i-CGA group they fell from 0.86 ± 0.24 to 0.68 ± 0.37, p = 0.22. Preferred place of death was largely adhered to in both groups, where documented. Of those with severe frailty, 55% (62/111) of the i-CGA group died, vs. 77% (43/56) of the control group, p = 0.0013. Conclusions: Proactive, community-based i-CGA can improve documentation of care home residents’ ACP preferences, and may reduce unplanned hospital admissions. In severely frail residents, a mortality reduction was seen in those who received an i-CGA.

Journal Article Type Article
Acceptance Date Feb 19, 2024
Online Publication Date Mar 19, 2024
Publication Date Mar 19, 2024
Deposit Date Mar 19, 2024
Publicly Available Date Mar 20, 2024
Journal BMC Geriatrics
Electronic ISSN 1471-2318
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 24
Issue 1
Article Number 269
Pages 269
DOI https://doi.org/10.1186/s12877-024-04824-6
Keywords Advanced care planning, Frailty, Care homes, Primary care, Geriatric assessment
Public URL https://uwe-repository.worktribe.com/output/11831486

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