IT’S NEVER TOO LATE TO START: A CASE FOR PREVENTATIVE OUTPATIENT GERIATRIC SERVICES

Abstract

INTRODUCTION & AIMS The population is ageing and the chronic disease burden growing, seeing more older adults present to hospital with preventable non-communicable diseases. Multidisciplinary outpatient teams are well placed to manage modifiable risk factors to prevent disease progression and hospitalisations. A preventative service was launched at Concord Hospital integrating geriatrician, exercise physiologist and dietitian care to optimise the physical and mental health of older adults with chronic disease and frailty. This evaluation aims to determine the success of service implementation and feasibility of the model. METHODS Between November 2022 and June 2023, 59 patients (mean age 80.2 years (SD 6.2), 47.5% female) completed 12-weeks of concurrent exercise and diet interventions with medical oversight. Patients were assessed pre- and post-interventions. Exercise was individualised and multimodal, performed twice weekly in a supervised group. Diet was individualised with a protein supplement prescribed as appropriate. The outcomes measured were Fried Frailty Phenotype (FFP), leg strength (one repetition maximum leg press), Short Physical Performance Battery (SPPB), Geriatric Depression Scale Short Form (GDS), and Mini Nutritional Assessment Long Form (MNA). Service activity was measured monthly via rate of referral and occasions of service (OOS). Data were analysed using JASP (v.0.18.1). RESULTS Monthly rate of referral and OOS increased from 18 to 51 patients and 49 to 479 occasions respectively, indicating service demand. After 12-weeks there were significant improvements in FFP (mean difference [95%CI] -0.4 [-0.7, -0.2] points), leg strength (34.0 [27.1, 40.8] kilograms), SPPB (1.1 [0.8, 1.5] points), GDS (-1.4 [-2.2, -0.6] points) and MNA (2.6 [1.6, 3.5] points), with no effect of sex observed. CONCLUSION Initial implementation of a preventative outpatient geriatric service was successful with increasing service demand and significant physical and mental health improvements. The service model is feasible; however, further evaluation is required to determine outcomes after continued service provision.