Integrated primary and geriatric care for frail older adults in the community: Implementation of a complex intervention into real life

Marco Inzitari, Laura Mónica Pérez, M. Belén Enfedaque, Luís Soto, Francisco Díaz, Neus Gual, Elisabeth Martín, Francesc Orfila, Paola Mulero, Rafael Ruiz, Matteo Cesari

Research output: Contribution to journalArticleResearch

8 Citations (Scopus)

Abstract

© 2018 European Federation of Internal Medicine Background: Frailty is highly prevalent in older persons and associated with negative health-related events and costs. Despite successful clinical trials, translation of evidence into implementation of dedicated programs has been scarce. This is probably due to funding limitations and lack of generalizability of rigid schemes adopted in controlled studies. We propose a guidance to implement complex interventions against frailty in the community, and describe the design and early findings of the +AGIL Barcelona program. Methods: A guidance “decalogue” resulted from an experts’ panel prioritization of recommendations by international independent bodies. On this basis, we reorganized existing primary care, geriatrics and community-based resources to implement our program, which includes a screening, a multi-component intervention modulated on the comprehensive geriatric assessment and integrated follow-up plus continuity through community-based resources. The pre-post impact of the program on physical function, as well as on clinical endpoints, person-center outcomes and costs will be assessed. Results: Integrated care, multi-component, person-centered strategies to empower the final users in a flexible and adaptable way should be promoted after raising awareness and potentially convey long term investments. In 22 months, 185 participants (mean age ± SD = 81.6 ± 5.7 years, 72% women) joined the program. Although independent in the activities of daily living, participants showed clear indicators of frailty (Short Physical Performance Battery = 7.1 ± 2.5; gait speed = 0.69 ± 0.2 m/s). Conclusions: +AGIL Barcelona may represent a unique model to manage frailty in older community-dwellers, translating evidence into pragmatic clinical practice. Further research will clarify the effects of this intervention.
Original languageEnglish
Pages (from-to)57-63
JournalEuropean Journal of Internal Medicine
Volume56
DOIs
Publication statusPublished - 1 Oct 2018

Keywords

  • Aging
  • Frailty
  • Geriatrics
  • Integrated care
  • Physical activity
  • Primary care

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