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. Study participants consisted of 218 GSH patients aged≥65, with CFS4 to CFS7.

Methods

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. 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 (M_diff=-0.2, 95 % CI [-1.8;1.3]) and 6-months (M_diff=-0.5, 95 % CI[-2.2;1.2]). Patient activation increased slightly at 3-months (M_diff=3.0, 95 % CI [0.1;5.9]) but not at 6-months (M_diff=1.5, 95 % CI [-1.2;4.1]). There were significant increases for health-related QoL a t 3-months (M_diff=0.068, 95 %CI [0.041;0.095]) and 6-months (M_diff=0.045, 95 % CI [0.016;0.074]), and for emotional-related QoL at 3-months (M_diff=2.3, 95 % CI [1.2;3.3]) and 6-months (M_diff=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.

SOURCE:
The Journal of Frailty & Aging

DOI:
https://doi.org/10.1016/j.tjfa.2025.100048

AUTHOR(S):
Nai ZL, Choo R, Sum G, Goh SF, Ding YY, Lim WS, Tan WS, Geriatric Service Hub Programme Group.