Helen Lyndon


Aim This mixed-methods feasibility study aimed to identify and to develop consensus on the components of a holistic assessment and care planning intervention for frail older people in primary care and to conduct a feasibility cluster randomised, controlled trial with an embedded qualitative study to assess potential trial methods for a definitive trial. Background Frailty is a serious but not inevitable consequence of ageing that can be managed as a long-tern condition. Frail older people are more at risk to adverse health outcomes than the non-frail, yet many do not receive evidence based management including a comprehensive geriatric assessment (CGA); a holistic assessment and care planning approach. This is because the impact of CGA is well evidenced in a hospital setting, but less so with community-dwelling frail older people who receive the majority of their healthcare and support in primary care. It is not clear if this approach can be successfully delivered in primary care and whether a holistic assessment and care planning intervention can be led by nurses rather than the traditional geriatrician-led model. Methods Firstly, a patient and public involvement consultation informed the design of this mixed-methods feasibility study. Then a three-round e-Delphi study was carried out to gain consensus on the content of the intervention. A multi-site, feasibility, cluster randomised controlled trial (fRCT) with embedded qualitative study was conducted. Findings The e-Delphi survey provided consensus on the important and feasible components of the intervention. This was then further refined by research stakeholders to produce the Holistic Assessment and care Planning Intervention (HAPPI) assessment pack to be used in the fRCT. The fRCT demonstrated that it was possible to conduct a randomised controlled trial of the intervention in primary care, all feasibility criteria relating to recruitment and retention were achieved, outcome measures evaluated, and recommendations made for a definitive trial. The qualitative study determined that the intervention was acceptable to participants and judged as feasible to deliver by the nurses. Trial processes and procedures were feasible with some changes. Conclusions The study adds new knowledge having developed a nurse-led intervention for older people with frailty that can be delivered in primary care. It has demonstrated that the intervention is feasible and provided information to inform the conduct of the definitive randomised controlled trial.

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