As the population ages, an increasing number of older people are living with frailty. A new Cochrane review from May 2023 looks at the evidence on the effects of case management for their integrated care. Here's one of the authors, Euan Sadler from the University of Southampton in the UK, to tell us about frailty and what they found.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. As the population ages, an increasing number of older people are living with frailty. A new Cochrane review from May 2023 looks at the evidence on the effects of case management for their integrated care. Here's one of the authors, Euan Sadler from the University of Southampton in the UK, to tell us about frailty and what they found.
Euan: Although there is no standard definition of frailty, it can be regarded as an age‐related reduced ability to recover quickly following a health problem, and can have a significant impact on the person's everyday activities. People living with frailty are at high risk of declining health and well‐being, and often experience poorly co‐ordinated health and care services. Integrated care, which is widely implemented in the UK and internationally, aims to improve co‐ordination of services and patient outcomes, and case management is one type of community‐based integrated care programme. These programmes are delivered by health or social care professionals, supported by a wider team. They include assessment, care planning, and co‐ordination of care to meet the needs of the individual.
No Cochrane reviews have looked at whether case management improves outcomes and reduces costs in people aged 65 years or older living with frailty, compared with standard care (usually involving management of care with a general practitioner) and we conducted this review to address that gap. We investigated the effects on mortality, admission to a nursing home, quality of life, complications that arose from taking part in the trial, function (covering physical, cognitive, emotional and social domains), hospital admission, and costs.
We identified 20 randomised trials, all from high-income countries, representing nearly 12,000 people living with frailty. We considered that the overall quality of the evidence was low or moderate, due to substantial variation between trials in the number of people enrolled, the definition of frailty, the setting of case management programmes, the care providers involved, and the time point of outcome measurement.
Based on the results of these trials, it's uncertain whether case management for integrated care of older people with frailty in community settings, compared to standard care, improved patient and service outcomes or reduced costs, over a follow‐up period ranging from three months to three years.
Thinking about how to use these findings, we acknowledge that applying evidence from the included trials to different settings is challenging when interventions are complex because they cross many organisational, social, and cultural boundaries. To help resolve this, new research is needed to determine the intervention components that are effective, and which should be included in future case management interventions. It would also be helpful to have agreement on a standardised definition of frailty, to inform future randomised trials that might identify how such interventions benefit some people and not others.
Mike: If you would like to read the review, and watch for future updates if the new trials become available, it's free to view at Cochrane Library dot com. Just go to the website and search 'integrated care for older people and frailty' to find it.