Nurse-led geriatric syndrome screening and intervention program for frail older inpatients in Singapore: a study protocol on implementation research and program evaluation

Background: Frailty confers greater risks of negative health outcomes in hospitalised older adults. To improve care for this vulnerable population, Comprehensive Geriatric Assessment (CGA) is recommended for frail older persons. However, implementing CGA outside of specialized geriatrician-led settings is limited, and few care models use frailty to identify and target older persons for CGA in the hospital-wide context.

Methods: This paper describes the study protocol of the implementation research and program evaluation of the Inpatient Nursing Frailty Assessment (INFA) program. The INFA program is designed to address these gaps by improving the identification and management of frailty and geriatric syndromes at a local hospital. Participants will be patients aged 65 and above, admitted to medical and surgical wards, who are mildly to moderately frail (Clinical Frailty Scale (CFS) 4–6) and not receiving inpatient geriatric care. There are two phases to the study: Pre-implementation and implementation. In the pre-implementation phase, we will elicit anticipated implementation barriers and enablers, and the updated Consolidated Framework for Implementation Research (CFIR) and its Outcomes Addendum as the implementation research tool to select, specify and develop implementation strategies to address contextual barriers. In the implementation phase, we apply a hybrid effectiveness-implementation study design and multi-methods approach. Implementation research outcomes include adoption, implementation, sustainability, and scalability. A quasi-experimental approach with intervention and control arms will compare the effects of the INFA program to usual care. The primary outcome is functional status (activities of daily living) at six months post-discharge. Secondary outcomes include patient outcomes (e.g., health-related quality of life), health service utilisation and cost, and a cost-effectiveness analysis.

Discussion: The INFA program is a novel approach that empowers nurses to provide early frailty assessment to frail older adults warded in acute hospitals under non-geriatrician care. This study uses implementation research to develop implementation strategies, assess implementation outcomes and evaluate the effectiveness of INFA. It aims to be a valuable blueprint to enhance the quality of care for frail older adults within the inpatient setting.

SOURCE:
BMC Geriatrics

DOI:
https://doi.org/10.1186/s12877-025-06861-1

AUTHORS:
Lim C, Ginting ML, Subramaniam A, Tang JY, Rodrigues EE, Chia JQ, Chua SY, Tan WS, Lim WS, Ding YY, Chew J, Sum G, INFA group.