AdvantAGE: Implementation and Evaluation of an Interprofessional Tranistional Care Model for Frail Older Adults

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-08

Study Completion Date

2026-06-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

This clinical trial at the University Department of Geriatric Medicine FELIX Platter in Basel, Switzerland, is designed to evaluate a new transitional care model aimed at helping frail older adults after they get discharged from the hospital. The AdvantAGE study aims to explore the following questions:

* Does the new care model help reduce the number of patients who need to return to the hospital within 90 days?
* How effective is the implementation of this care model?

Participants in the trial will be followed by advanced practice nurses for up to 90 days after hospital discharge. The patients and their caregivers will receive support in coordinating care, managing medications, and learning to manage the patient's health conditions on their own. Additionally, they will have the opportunity to engage in discussions about advanced care planning.

Related Clinical Trials

Explore similar clinical trials based on study characteristics and research focus.

Improving Aging in Place in Subsidized Housing

NCT04212442

Physical Disability Cognitive Impairment Physical Activity

COMPLETED NA

Continuum of Care for Frail Elderly People

NCT01260493

Frail Elderly People

COMPLETED NA

Efficacy of Integrated Care to Reduce Hospitalization and Nursing Home Placement in Community Dwelling Frail Elderly

NCT02084108

Chronic Diseases

COMPLETED NA

Assessment of the Relevance of a Medico-social Care of Elderly Patients, in Relay Between Hospital and Home: Experimentation of TEMPORARY HERBERGEMENT in Retirement Home " EHPAD " in Seine-et-Marne Department

NCT04014049

Patients Beneficiting of Temporary Hebergement

TERMINATED

SUPPORT FOR FRAIL ELDERLY PERSONS - From Prevention to Palliation

NCT00877058

Frail Elderly Persons

COMPLETED NA

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Transitional Care Multimorbidity Geriatric Care

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

NA

Intervention Model

SINGLE_GROUP

Hybrid effectiveness-implementation study (type 1)

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Intervention group

The intervention includes five core elements provided by a multiprofessional team: (1) continuous support for patients and caregivers; (2) care coordination with primary care providers;(3) visits at patients' homes; (4) medication- and self-management with patients and caregivers; and (5) proactive advanced care planning. Patients will receive specialized support including home visits up to 90 days after hospital discharge.

Group Type EXPERIMENTAL

Transitional care model

Intervention Type OTHER

A newly developed care model to support frail older adults during their transition from hospital to home.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Transitional care model

A newly developed care model to support frail older adults during their transition from hospital to home.

Intervention Type OTHER

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

AdvantAGE

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Currently admitted to the acute or rehabilitation ward of University Department of Geriatric Medicine
* Reside in Basel-Stadt
* Possess the ability to speak and comprehend the German language
* Scheduled to be discharged to their home
* 65 years or older
* Identified by a clinician as having a high risk of deterioration due to frailty

Additionally, participants must meet at least one of the following criteria:

* diagnosed with a complex chronic disease requiring support in self-management and disease management, or
* facing socially challenging situations such as living alone without a supportive network or lacking a GP, or
* admitted for an acute illness with a brief hospital stay (e.g., infection, cardiac decompensation) and need support in self- and disease management, and continuity of the therapy plan, including close monitoring.

Exclusion Criteria

* residing in a nursing home or being newly admitted to one
* lacking informal caregivers and exhibiting severe cognitive impairment (MMS ≤23)
* scoring \<50 on the motoric domain of the Functional Independence Measure (FIM)
* having a psychiatric disorder that significantly impacts their ability to manage daily life at time of the discharge

Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No