Ze Ling Nai, Robin Choo, Grace Sum, Siew Fong Goh, Yew Yoong Ding, Wee Shiong Lim, Woan Shin Tan
{"title":"新加坡社区老年人虚弱管理项目的患者结局：队列评估。","authors":"Ze Ling Nai, Robin Choo, Grace Sum, Siew Fong Goh, Yew Yoong Ding, Wee Shiong Lim, Woan Shin Tan","doi":"10.1016/j.tjfa.2025.100048","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.</p><p><strong>Objectives: </strong>We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.</p><p><strong>Design: </strong>Single-arm pre-post design.</p><p><strong>Setting: </strong>Community-based health and social care provider PARTICIPANTS: 218 GSH patients, aged≥65, with CFS4 to CFS7.</p><p><strong>Intervention: </strong>Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.</p><p><strong>Measurements: </strong>Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.</p><p><strong>Results: </strong>We studied 191 (87.6 %) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (M<sub>diff</sub>=-0.2, 95 % CI [-1.8;1.3]) and 6-months (M<sub>diff</sub>=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (M<sub>diff</sub>=3.0, 95 % CI [0.1;5.9]) but not at 6-months (M<sub>diff</sub>=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (M<sub>diff</sub>=0.068, 95 %CI [0.041;0.095]) and 6-months (M<sub>diff</sub>=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (M<sub>diff</sub>=2.3, 95 % CI [1.2;3.3]) and 6-months (M<sub>diff</sub>=1.5, 95 % CI [0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6-7.</p><p><strong>Conclusions: </strong>Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. Sub-group analyses suggest that GSH is beneficial for patients categorised as CFS4 and CFS5, but the programme played a largely maintenance role for patients with CFS6-7.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 4","pages":"100048"},"PeriodicalIF":3.3000,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184049/pdf/","citationCount":"0","resultStr":"{\"title\":\"Patient-outcomes of a frailty management program for community-dwelling older adults in Singapore: A cohort evaluation.\",\"authors\":\"Ze Ling Nai, Robin Choo, Grace Sum, Siew Fong Goh, Yew Yoong Ding, Wee Shiong Lim, Woan Shin Tan\",\"doi\":\"10.1016/j.tjfa.2025.100048\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.</p><p><strong>Objectives: </strong>We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.</p><p><strong>Design: </strong>Single-arm pre-post design.</p><p><strong>Setting: </strong>Community-based health and social care provider PARTICIPANTS: 218 GSH patients, aged≥65, with CFS4 to CFS7.</p><p><strong>Intervention: </strong>Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.</p><p><strong>Measurements: </strong>Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.</p><p><strong>Results: </strong>We studied 191 (87.6 %) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (M<sub>diff</sub>=-0.2, 95 % CI [-1.8;1.3]) and 6-months (M<sub>diff</sub>=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (M<sub>diff</sub>=3.0, 95 % CI [0.1;5.9]) but not at 6-months (M<sub>diff</sub>=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (M<sub>diff</sub>=0.068, 95 %CI [0.041;0.095]) and 6-months (M<sub>diff</sub>=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (M<sub>diff</sub>=2.3, 95 % CI [1.2;3.3]) and 6-months (M<sub>diff</sub>=1.5, 95 % CI [0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6-7.</p><p><strong>Conclusions: </strong>Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. 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Patient-outcomes of a frailty management program for community-dwelling older adults in Singapore: A cohort evaluation.
Background: There is urgency to manage frailty due to its increasing prevalence. The Geriatric Service Hub (GSH) is a novel programme in Singapore, which aims to manage frailty amongst community-dwelling older adults.
Objectives: We aimed to (1) assess the effectiveness of the GSH through patient-outcomes including patient activation, functional status, and quality-of-life (QoL), and (2) assess impact on patient-outcomes through different levels of frailty using the Clinical Frailty Scale (CFS) scores.
Design: Single-arm pre-post design.
Setting: Community-based health and social care provider PARTICIPANTS: 218 GSH patients, aged≥65, with CFS4 to CFS7.
Intervention: Patients received comprehensive geriatric assessments in community-based settings and had individualised care plans formed by a multi-disciplinary care team. Patients were then referred to health and social services located in the community based on identified needs.
Measurements: Functional status (Barthel Index), Patient activation (Patient Activation Measure), health-related QoL (EuroQoL 5-dimension 5-level tool) and the emotional-related QoL (Control, Autonomy, Self-realisation, and Pleasure tool). Measurements administered at baseline, 3- and 6-months post-enrolment. Analysis included unadjusted t-tests and multi-level mixed-effects linear regression.
Results: We studied 191 (87.6 %) participants who completed all 3-timepoints. Compared to baseline, functional status was maintained at 3-months (Mdiff=-0.2, 95 % CI [-1.8;1.3]) and 6-months (Mdiff=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (Mdiff=3.0, 95 % CI [0.1;5.9]) but not at 6-months (Mdiff=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (Mdiff=0.068, 95 %CI [0.041;0.095]) and 6-months (Mdiff=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (Mdiff=2.3, 95 % CI [1.2;3.3]) and 6-months (Mdiff=1.5, 95 % CI [0.4;2.7]). For sub-group analyses, there were significant increases for patient activation and both QoL measurements for patients categorised as CFS4 and CFS5, and no significant changes for patient-outcomes for CFS6-7.
Conclusions: Overall, results suggest maintenance in patient activation and functional status, with improvements in QoL. Sub-group analyses suggest that GSH is beneficial for patients categorised as CFS4 and CFS5, but the programme played a largely maintenance role for patients with CFS6-7.
期刊介绍：
The Journal of Frailty & Aging is a peer-reviewed international journal aimed at presenting articles that are related to research in the area of aging and age-related (sub)clinical conditions. In particular, the journal publishes high-quality papers describing and discussing social, biological, and clinical features underlying the onset and development of frailty in older persons. The Journal of Frailty & Aging is composed by five different sections: - Biology of frailty and aging In this section, the journal presents reports from preclinical studies and experiences focused at identifying, describing, and understanding the subclinical pathophysiological mechanisms at the basis of frailty and aging. - Physical frailty and age-related body composition modifications Studies exploring the physical and functional components of frailty are contained in this section. Moreover, since body composition plays a major role in determining physical frailty and, at the same time, represents the most evident feature of the aging process, special attention is given to studies focused on sarcopenia and obesity at older age. - Neurosciences of frailty and aging The section presents results from studies exploring the cognitive and neurological aspects of frailty and age-related conditions. In particular, papers on neurodegenerative conditions of advanced age are welcomed. - Frailty and aging in clinical practice and public health This journal’s section is devoted at presenting studies on clinical issues of frailty and age-related conditions. This multidisciplinary section particularly welcomes reports from clinicians coming from different backgrounds and specialties dealing with the heterogeneous clinical manifestations of advanced age. Moreover, this part of the journal also contains reports on frailty- and age-related social and public health issues. - Clinical trials and therapeutics This final section contains all the manuscripts presenting data on (pharmacological and non-pharmacological) interventions aimed at preventing, delaying, or treating frailty and age-related conditions.The Journal of Frailty & Aging is a quarterly publication of original papers, review articles, case reports, controversies, letters to the Editor, and book reviews. Manuscripts will be evaluated by the editorial staff and, if suitable, by expert reviewers assigned by the editors. The journal particularly welcomes papers by researchers from different backgrounds and specialities who may want to share their views and experiences on the common themes of frailty and aging.The abstracting and indexing of the Journal of Frailty & Aging is covered by MEDLINE (approval by the National Library of Medicine in February 2016).
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