Abstract
Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.
Highlights
Older adults are among the highest users of acute care hospital and rehabilitation services (Boltz et al, 2012 and Smyth et al, 2017)
Hospital associated decline (HAD) is the term used to describe a new functional or cognitive deficit that develops during hospitalisation that was not present at admission (Zisberg et al, 2015)
Capability physical
Summary
Older adults are among the highest users of acute care hospital and rehabilitation services (Boltz et al, 2012 and Smyth et al, 2017). Patients are older with higher levels of co-morbidity, physical and cognitive frailty, and polypharmacy (Buurman et al, 2011; Walsh et al, 2019). Due to these underlying vulnerabilities, this group are more susceptible to hospital harm and prolonged hospitalisation. Hospital associated decline (HAD) is the term used to describe a new functional or cognitive deficit that develops during hospitalisation that was not present at admission (Zisberg et al, 2015). The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity)
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