A physiotherapist assesses the gait function of 92-year-old Else Andersen before she is discharged from Department of Geriatrics (photo: Tonny Foghmar).
In recent research, Department of Geriatrics at Aarhus University Hospital (AUH) has shown that screening for frailty in the older patients leads to targeted interventions to prevent loss of functional level, readmission and death; moreover, it strengthens the role of relatives.
Else Andersen is 92 years old and admitted to Department of Geriatrics at AUH. She is treated for a large wound on the leg, and she receives medical treatment for a urinary tract infection. Over the years, her vision has become worse, and she also finds it increasingly difficult to remember things.
Soon Else will be discharged to her own home, a town 20 km away from the hospital - luckily, her daughter lives in the same town. Before Else is discharged, the staff assess how frail she is. A doctor, a nurse and a physiotherapist assess her social, physical, cognitive, disease and nutritional status. After discharge, the follow-up for Else will be based on the results of this comprehensive assessment.
Else is one of the many older patients who since 2018 have been routinely screened for frailty before discharge from Department of Geriatrics. The development of this screening practice is based on a number of research projects on frailty in the older patients.
From treatment of hip fracture to screening for frailty
The idea to screen older patients for frailty was forged in connection with a PhD project on hip fracture in older nursing home residents by Merete Gregersen, clinical nurse specialist at Department of Geriatrics. She found that frail older patients with hip fracture improved remarkably when their hemoglobin level was increased after blood transfusion. However, not only the nursing home residents are frail.
Therefore, Else Marie Damsgaard, professor at Department of Geriatrics, initiated an interdisciplinary research project to identify frailty in older patients. The research was inspired by Italian researchers who have developed a so-called multidimensional prognostic index (MPI) to assess the social, physical, cognitive, disease and nutritional status in geriatric patients. Department of Geriatrics has used the MPI tool in different research projects by assessing the older hospitalized patients.
- One of our research projects showed that frail older patients have a higher risk of unplanned readmissions. Another project indicated that frail elderly after discharge benefit more from early follow-up in their own home by a multidisciplinary geriatric team compared with follow-up by a nurse in primary care, says Merete Gregersen.
The department has also conducted a research project on the effect of relatives participating in the first follow-up visit in the home of severely frail older persons living alone. The results showed that when a relative participates in the follow-up visit, the risk of readmission of the frail elderly is lower.
- When participating in the follow-up visit, the relatives probably feel safer about the elderly just discharged from hospital and still uncertain on how it will work at home. They know what to do if the elderly person gets ill again – and who to contact if they need help.
Huge potential in helping frail elderly
The frail elderly will certainly be found among the nursing home residents, but 55% of the frail patients in the Department of Geriatrics are living alone in their own home.
- In the group of moderately frail older patients, we see that it has a substantial impact to intervene. The potential of helping the frail elderly is huge, says Merete Gregersen.
Doctors, nurses and therapists at Department of Geriatrics have already planned several new research projects including the frail older patients. For example to study the effect of early geriatric intervention combined with fecal microbiota transplantation in frail older patients with diarrhea. The intervention can take place both in hospital and in the patient's home. The aim is that the treatment will prevent loss of physical functional capacity and quality of life, and increase survival.
HOW IS THE RESEARCH FINANCED?
- Department of Geriatrics, AUH and Municipality of Aarhus have received DKK 3.5 million from the Danish Health Authority (special pool for initiatives in health and the elderly 2016-2019) for projects on strengthening efforts and coherence in the weakest elderly discharged from hospital to primary care
- Geriatric research projects have received minor funding from various sources
Generally, major funding of research projects within geriatrics (diseases of the elderly) is difficult