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Frailty and complexity among home service recipients: a case-control longitudinal study

English title Frailty and complexity among home service recipients: a case-control longitudinal study
Applicant Ludwig Catherine
Number 179453
Funding scheme Project funding (Div. I-III)
Research institution Haute Ecole de Santé de Genève (HEdS) HES-SO
Institution of higher education University of Applied Sciences and Arts Western Switzerland - HES-SO
Main discipline Health
Start/End 01.09.2018 - 28.02.2021
Approved amount 331'092.00
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Keywords (5)

complexity; nursing; screening; frailty; homecare

Lay Summary (French)

Lead
Le repérage précoce des personnes fragiles et des cas/situations complexes constituent deux éléments incontournables à la mise en place de stratégie de prévention d’évènements indésirables en santé dans la population vieillissante. Ce projet se propose de développer des indicateurs de fragilité et de complexité à partir d’évaluations gériatriques standardisées effectuées au moyen du Resident Assessment Instrument - Home Care. Il vise aussi à estimer la validité prédictive de ces indicateurs en regard d’évènements indésirables en santé sur la base d’un suivi à 18 mois de participants âgés de 65 ans et plus. A l’issue du projet, des recommandations de bonnes pratiques seront proposées aux professionnels des aides et soins à domicile pour favoriser l’identification précoce de personnes âgées fragiles et de cas/situations de soins complexes.
Lay summary

Contenu et objectifs du travail de recherche

Ce projet  a pour objectif de développer des algorithmes de calcul de fragilité et de complexité basés sur le RAI-HC et, ce faisant, de fournir aux professionnels des soins à domicile des outils de dépistage valides et fiables pour leur pratique de routine. Le projet se propose également d'évaluer la validité prédictive des indices proposés en regard d’évènements de santé indésirables tels que les chutes, les hospitalisations, ou les décès qui seront documentés sur la base d’un suivi longitudinal des participants sur 18 mois. De plus, en comparant des échantillons de personnes sans soins ou aides formelles, avec aides formelles et avec soins formels, le projet se propose d’identifier les sous-groupes de la population âgée pour lesquels le dépistage précoce apparaît le plus pertinent. Les résultats de cette étude cas-témoin longitudinale permettront de développer  des recommandations de bonne pratique à visée de stratégies préventives adaptées et répondant aux besoins de santé de la population vieillissante.

Contexte scientifique et social du projet de recherche

Dans le contexte de virage ambulatoire du système de santé suisse, les professionnels des soins à domicile sont acteurs important pour le repérage précoce des personnes fragiles et des cas/situations de soins complexes. Le développement d’indicateurs de fragilité et de complexité à partir du RAI-HC, l’instrument infirmier recommandé en Suisse pour l’élaboration de plans de soins individualisés, permettra d’outiller les professionnels de la santé pour le repérage précoce des personnes fragiles et situations complexes. Le projet permettra aussi de mieux comprendre les relations entre fragilité et complexité, deux notions souvent évoquées en gérontologie, mais à ce jour, peu étudiées simultanément.
Direct link to Lay Summary Last update: 18.04.2018

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Abstract

Like most industrialized countries, Switzerland is witnessing population aging and increasing rates of chronic diseases and comorbidities, with resulting widening arrays of care needs among older citizens. In this context, two major challenges need to be addressed. The first is early screening of individuals at risk of functional decline to immediately engage targeted preventive intervention. The second is early identification of patients with complex care needs to rapidly adjust care plans and prevent undesirable health outcomes. In the face of these challenges, clinicians and scholars call for the early screening of frailty and complexity and recommend it as a critical step in preventive and long-term care strategies devoted to elders. As such, early screening should also contribute to reduce costs, both for the individuals and for the health system.In Switzerland, health policies foster shorter hospital stays to the benefit of “aging in place.” In such a system, homecare professionals are key actors in warranting that adapted care is delivered to aging individuals. At present, homecare nurses already contribute to this endeavor by routinely identifying care needs and by delivering individualized care plans. In everyday practice, many homecare nurses use the Resident Assessment Instrument-Home Care (RAI-HC), a comprehensive geriatric assessment tool specifically dedicated to identifying care needs. Yet, recent evidence suggests that the RAI-HC could further be used to derive compound scores with a high clinical value, among them, estimates of frailty. These encouraging findings offer new opportunities to provide RAI-HC users with screening tools acknowledged as useful means for health professionals willing to enhance care in aging populations. The purpose of the present project is to develop frailty and complexity computation algorithms based on the RAI-HC and, in doing so, to provide homecare nurses with valid and reliable screening tools for their routine practice. By relying on a prospective observational case-control longitudinal study, the project intends to assess the predictive validity of the proposed indices with respect to undesirable health outcomes. Repeated measurement occasions, separated by 6-month intervals, will also allow for estimation of intra-individual change in frailty and complexity. In the study, elders living in the community and aged 65 or older are the target population, and three samples will be considered based on the a priori risks of adverse outcomes. These groups will be compared on the observed rates of frailty and complexity and on their evolution over time. Results will allow for identification of subgroups of the aged population for whom early screening of frailty and complexity appears most relevant. Based on the findings, practice guideline will be proposed. They will entail the interpretation of the scores and recommendations for mounting adapted preventive strategies. Finally, the project will contribute to enhancing knowledge on the relation between frailty, a well-known concept in gerontology, and complexity, a concept increasingly referred to in the care literature but that still deserves operational and consensual definitions. The identification of frail elders and individuals with complex needs is of utter importance for health professionals concerned by the quality of care delivered to aging patients. By providing homecare nurses with frailty and complexity screening tools and recommendations for use, this project intends to outfit key actors of the Swiss health system with means to enhance their part in a collective endeavor targeting best care and best quality of life for our aged citizens
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