Help Optimise and Mobilise Elders (H.O.M.E)

NCT05484063 | Unknown

• 1 other identifier: GERI1627
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 2

Brief Summary

During hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. This leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. The investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. As such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in Singapore. The investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid Type 2 design where both effectiveness and implementation spheres are tested simultaneously.

Conditions

Mobility Limitation; Functional Disturbance

Keywords

Elderly; Geriatric; Mobility; Inpatient; Functional Decline; Mobility Intervention; Gait speed; Maximum distance walked; Cost impact; length of stay; Multidisciplinary; Implementation study; 4Ms (Mobility, Mentation, Medication, What Matters); Nursing screen; Group therapy

Outcome Measures

Primary Outcomes (2)

• Change in maximum distance walked

  The total distance covered by the research participant (in meter)

  Upon admission and at the point of discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)

• Mobilisation frequency

  Number of times mobilised. The average mobilisation frequency will be calculated by dividing the sum by the number of admission days.

  Through the duration of admission

Secondary Outcomes (6)

• Change in modified barthel score

  Upon admission, at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay), and one-month post discharge

• Change in gait speed

  Upon admission and at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)

• Inpatient length of stay and discharge location

  The duration of admission and upon discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)

• Presence of common iatrogenic complications such as delirium, injurious falls, pressure ulcers, and venous thromboembolisms

  At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)

• Gross amount of patient's bill during index admission, considering subsidy level

  At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)

Other Outcomes (6)

• Mortality

  1-month follow-up post-discharge

• Readmission

  1-month follow-up post-discharge

• Healthcare utilisation data and associated costs

  1-month follow-up post-discharge

Study Arms (2)

Intervention

EXPERIMENTAL

Intervention group will receive a multicomponent, mobility-focused intervention during the course of inpatient admission.

Other: Multicomponent, mobility-focused intervention

Control

NO INTERVENTION

The control group will receive usual care as per current ward practice.

Interventions

Multicomponent, mobility-focused intervention OTHER

The intervention group will receive early therapist review (within one working day of admission to HOME unit), to be mobilised at least three times a day. They will also receive additional group exercise therapy sessions, as well as nurse screening for geriatric syndromes. Besides that, they will be screened for 4Ms (Mobility, Mentation, Medication, What Matters) by doctor on admission.

Intervention

Eligibility Criteria

• Age: 21 Years - 110 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Newly admitted patients to the geriatric service
• Aged 75 years and above
• Mobile with or without the use of a walking aid

You may not qualify if:

• Vancomycin-resistant enterococcus (VRE) status
• Requires droplet or airborne precautions
• Critically ill
• Haemodynamically instability
• Requires more than 4-hourly parameters
• Systolic blood pressure \<90 mmHg
• Heart rate \>100beats/min
• Non-ambulant patients
• With advanced dementia (Functional Assessment Staging Scale \[FAST\] 7 dementia)
• Fulfills direct admission to another subspecialty unit

Sponsors & Collaborators

• JurongHealth: lead
• Geriatric Education and Research Institute: collaborator
• National Healthcare Group, Singapore: collaborator

Study Sites (2)

Ng Teng Fong Hospital

Singapore, 609606, Singapore

Location

Geriatrics Education and Research Institute

Singapore, 768024, Singapore

Location

Related Publications (25)

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MeSH Terms

Conditions

Mobility Limitation

Condition Hierarchy (Ancestors)

Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Melanie Tan Dr

  Ng Teng Fong General Hospital

  PRINCIPAL INVESTIGATOR

• Lau Lay Khoon Dr

  Geriatric Education and Research Institute

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Melanie Tan Dr

CONTACT

67165237; melanie_tan@nuhs.edu.sg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Model Details: It is a quasi-experimental design study.

Study Record Dates

• First Submitted: June 25, 2022
• First Posted: August 2, 2022
• Study Start: July 25, 2022
• Primary Completion: January 31, 2023
• Study Completion: September 30, 2023
• Last Updated: August 2, 2022

Record last verified: 2022-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: During study period.
• Access Criteria: Via secure platforms (files to be encrypted with password). For the purposes of data sharing and data analysis.

Locations

SG (2)