Efficacy of an Active Geriatric Evaluation for Geriatric Syndromes to Prevent Functional Decline in Family Medicine

NCT02618291 | Completed

• 1 other identifier: 32003B_159863/1
• Study Type: interventional
• Target: 429
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to test the efficacy of a comprehensive assessment and management tool (AGE: Active Geriatric Evaluation) for geriatric syndromes to prevent functional decline in elderly patients followed in family medicine. Family practitioners will be randomised either to the intervention, consisting of a yearly screening for eight geriatric syndromes accompanied by a management plan in case of positive screening, or to usual care. Level of functioning and quality of life of patients in both arms will be assessed over two years.

Conditions

Geriatric Syndrome; Functional Ability

Keywords

primary health care

Outcome Measures

Primary Outcomes (2)

• Instrumental Activities of Daily Living (IADL)

  Proportion of patients losing at least 1 instrumental IADL (8 items developed to assess functional status)

  2 years

• Basic Activities of Daily Living (ADL)

  Proportion of patients losing at least 1 basic ADL (6 items developed to assess functional status)

  2 years

Secondary Outcomes (5)

• Incidence of hospital admissions

  During 2 years

• Incidence of institutionalization

  During 2 years

• Incidence of emergency visits

  During 2 years

• Incidence of outpatient visits

  During 2 years

• Health related quality of life (WHOQOL-OLD) score

  2 years

Other Outcomes (2)

• Adhesion to Active Geriatric Evaluation Tool

  2 years

• Total cost

  2 years

Study Arms (2)

Active Geriatric Evaluation (AGE tool)

EXPERIMENTAL

The Active Geriatric Evaluation is a comprehensive assessment and management tool consisting of a 20-minute clinical screening instrument (Brief Assessment Tool, BAT) to identify 8 geriatric syndromes, and complementary diagnostic evaluations and propositions of management \& treatment for each syndrome.

Other: Active Geriatric Evaluation (AGE tool)

Usual care

ACTIVE COMPARATOR

No specific intervention will be provided to the patients, except what family practitioners (FPs) usually do. In this regard, it is possible that some FPs might use structured interventions similar to the AGE tool. This will be neither encouraged nor discouraged. FPs in the "usual care" arm will be asked to perform one BAT after 2 years of follow-up, at the final patient visit.

Other: Usual care

Interventions

Active Geriatric Evaluation (AGE tool) OTHER

Yearly administration of the brief assessment tool (BAT). Once the presence of one or more geriatric syndromes is suspected using the brief assessment tool, a management strategy is proposed. It is divided in two distinct steps: 1) perform additional tests to confirm or exclude the diagnosis and 2) to propose specific management attitudes. All proposed attitudes are based on literature review and geriatrician expertise. The FP remains free to follow the proposed attitudes.

Also known as: Active geriatric evaluation

Active Geriatric Evaluation (AGE tool)

Usual care OTHER

No specific intervention will be provided to the patients, except what family practitioners (FPs) usually do. In this regard, it is possible that some FPs might use structured interventions similar to the AGE tool. This will be neither encouraged nor discouraged. FPs in the "usual care" arm will be asked to perform one BAT after 2 years of follow-up, at the final patient visit.

Usual care

Eligibility Criteria

• Age: 75 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Older Adult (65+)

You may qualify if:

• Aged 75 years or more
• Consider the enrolling physician as his/her reference FP
• Able to understand French
• Living at home (not in institutions)
• Visited his/her FP at least twice during the past year
• Giving signed informed consent (or, in the absence of discerning capacity, giving assent in the presence of a surrogate signing the consent form)

You may not qualify if:

• Having had a geriatric or specialized memory consultation in the past 3 months (including assessment during rehabilitation)
• Planning to leave the study area or to change of FP in the next 2 years

Sponsors & Collaborators

• University of Lausanne: lead

Study Sites (1)

Department of Ambulatory Care and Community Medicine

Lausanne, Canton of Vaud, 1011, Switzerland

Location

Related Publications (2)

• Mueller Y, Schwarz J, Monod S, Locatelli I, Senn N. Use of standardized brief geriatric evaluation compared with routine care in general practice for preventing functional decline: a pragmatic cluster-randomized trial. CMAJ. 2021 Aug 23;193(33):E1289-E1299. doi: 10.1503/cmaj.202887.

  PMID: 34426445 DERIVED

• Schnegg D, Senn N, Bugnon O, Schwarz J, Mueller Y. Drug Prescription in Older Swiss Men and Women Followed in Family Medicine. Drugs Real World Outcomes. 2020 Mar;7(1):87-95. doi: 10.1007/s40801-019-00175-6.

  PMID: 31845213 DERIVED

Study Officials

• Nicolas Senn, MD PhD

  Department of community medicine and ambulatory care, University of Lausanne

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of research and de development centre

Study Record Dates

• First Submitted: November 24, 2015
• First Posted: December 1, 2015
• Study Start: June 1, 2016
• Primary Completion: January 31, 2020
• Study Completion: January 31, 2020
• Last Updated: February 21, 2021

Record last verified: 2021-02

Locations

CH (1)