Improving care for frail older patients after hospital discharge

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This study evaluates the impact of active follow-up by a case manager on frail older patients discharged from an acute geriatric hospital ward. It aims to assess whether this follow-up can help maintain or increase independence in daily activities, improve self-rated health and life satisfaction, enhance satisfaction with healthcare, and reduce healthcare consumption. The study will compare outcomes between patients receiving active follow-up and those who do not, while also considering the feasibility of the intervention from the perspectives of both caregivers and patients.

Why it matters

Who can join: the full rules

Inclusion Criteria:

75 years or older, screened as frail, admitted to an acute geriatric ward working according to CGA at the Sahlgrenska or Mölndal hospital. Both hospitals are part of Sahlgrenska University hospital, with the same catchment area, including Gothenburg with surrounding municipalities. People in the region can seek care at both hospitals. The orthopaedic clinic is situated at Mölndal hospital, resulting in most patients with fractures being admitted to this hospital, irrespective of in which municipality they are living. Cognitive impairment is not an exclusion criterion. For people who cannot give informed consent due to cognitive impairment, next of kin will be asked to assist with the consent.

Exclusion Criteria:

Less that 75 years old, Not residing in a permanent residence.

Where it's running

• University of Gothenburg
  Gothenburg, Sweden Recruiting

Study contacts

• Study coordinator: Theresa Westgård, PhD, Associate Professor
• Email: Theresa.westgard@neuro.gu.se
• Phone: 18628820334

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.