The Impact of Domiciliary Versus 'Hub' Based Comprehensive Geriatric Assessment on Clinical and Process Outcomes Among Older Adults Attending Community Specialist Teams: a Randomised Controlled Trial.

NCT06205238 | Active Not Recruiting

• 1 other identifier: HRB RL2020-010
• Study Type: interventional
• Target: 106
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators plan to implement a randomised controlled trial to examine the impact of domiciliary (home based) versus 'hub-based' Comprehensive Geriatric Assessment (CGA) on clinical and process outcomes among older adults referred to a community specialist team for older persons in the Mid-West region of Ireland. The population of interest is older adults who are discharged directly from the Emergency Department or referred urgently from their General Practitioner. The outcomes of interest focus on those that matter most to older adults as well as clinical and process measures of care.

Conditions

Frailty; Comprehensive Geriatric Assessment; Older Adults; Domiciliary Care

Outcome Measures

Primary Outcomes (4)

• Functional status

  Barthel Index

  Baseline

• Functional status

  Barthel Index

  6-weeks

• Functional status

  Barthel Index

  6-months

• Functional status

  Barthel Index

  12-months

Secondary Outcomes (25)

• Unplanned ED revisit

  Baseline

• Unplanned ED revisit

  6-weeks

• Unplanned ED revisit

  6-months

• Unplanned hospitalisation

  Baseline

• Unplanned hospitalisation

  6-weeks

Study Arms (2)

Domiciliary CGA

EXPERIMENTAL

The intervention will consist of domiciliary CGA including nursing, medical and allied health assessment and intervention for frail older adults over age 75 who are discharged the ED or referred urgently from their GP and referred to the CST in Limerick. The bulk of this intervention will be delivered in the patient's own home. Each participant will be required to attend the hub for their medical review where they will access specialist geriatric medical expertise. A domiciliary visit to the older person within 24-48 hours of referral from the ED or within 24-48 hours of triage of GP referral by a member of the multidisciplinary team. This person will act as the case coordinator. During this visit, there will be a detailed assessment of the older adult. Referrals will be made for domiciliary care to the appropriate healthcare professionals based on patient. The template proposed by Ellis et al. (2017) will be used to characterise the components of the CGA intervention.

Other: CGA

Hub-based CGA

ACTIVE COMPARATOR

The intervention will consist of CGA as defined above, including nursing, medical and allied health assessment and intervention for frail older adults over age 75 who are discharged the ED or referred urgently from their General Practitioner and referred to the CST in Limerick and will be seen in the Out-patient CST setting.

Other: CGA

Interventions

CGA OTHER

CGA is defined as a "multidimensional interdisciplinary diagnostic process focused on determining a frail elderly person's medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long term follow up".

Domiciliary CGA; Hub-based CGA

Eligibility Criteria

• Age: 75 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Referred to the CST hub from a General Practitioner (urgent referral) or from the ED at University Hospital Limerick.
• All of criteria 1-5 must be met
• years and over
• Evidence of frailty, scoring between 4 and 6 on the Rockwood Clinical Frailty Scale (pre-frail, mildly frail or moderately frail)
• Resides within CHO 3 and the catchment area of the relevant ICPOP hub
• Patient has been assessed in-person by the referrer
• Patient has not had MDT input within the last three months (excluding OPTIMEND team)
• And any one of criteria 6-10 must be met:
• Fall within the last month unrelated to acute cardiac or neurological cause \& no previous falls assessment
• Increased dependency or increased carer burden in the last month
• A deterioration in swallow in the last month including symptoms of recurrent chest infections, weight loss, coughing when eating/drinking, self-modifying diet secondary to difficulties
• Adverse drug reaction within the last month excluding allergic reaction Referred from ED/AMU following review by consultant in Emergency Medicine, Acute Medicine, Geriatric Medicine, General Medicine or Frailty at the Front Door team

You may not qualify if:

• Present with an acute neurological or cardiovascular event
• Are more appropriate to an alternative care pathway or service e.g. primary care or geriatric medicine clinic
• Present with injuries, unless the injury has already been appropriately managed,
• Are experiencing an acute medical illness requiring treatment in an acute hospital setting
• If care is being provided by other health care professionals at the time of referral and it is apparent that they are working to meet goals aligned with the current service
• They require investigation or treatment not available in the relevant ICPOP hub (unless these investigations are already being arranged elsewhere)
• They have had MDT input in the last three months
• Have confirmed or suspected Covid-19 infection

Sponsors & Collaborators

• University of Limerick: lead

Study Sites (1)

Community Specialist Team Hub

Limerick, Munster, Ireland

Location

MeSH Terms

Conditions

Frailty

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Outcome assessor will be blinded to group allocation to reduce detection bias.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 3, 2024
• First Posted: January 12, 2024
• Study Start: January 15, 2024
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): July 31, 2026
• Last Updated: August 20, 2025

Record last verified: 2025-08

Locations

IE (1)