The Effectiveness of an Outpatient Personalized Multidisciplinary Intervention Model, Guided by Comprehensive Geriatric Assessment, for Pre-Frail and Frail Elderly

ABSTRACT

Background: Our study evaluates the efficacy of an outpatient personalized multidisciplinary intervention model guided by comprehensive geriatric assessment (CGA), for pre-frail and frail elderly. Methods: A single-arm self-controlled study was conducted at the outpatient departments (OPD) of a medical center in Taiwan. Subjects received personalized multidisciplinary intervention, including physical therapy, psychotherapy, a nutritional consultation, precise medicine, and social resource linkage, as determined by the results of their CGAs. After 3 months of interventions, change in the proportions of the frail status (frail, pre-frail and robust), functional scores, depressive status, cognition, nutritional status, percentage of inappropriate medication used and social resource usage were analyzed. A logistic regression model was applied to determine the predictive factors associated with an improvement in frail severity. Results: A significant improvement in frail status was found (proportion of frail 44.5% versus 23.1%, p < 0.001). Physical function, depressive and nutritional status were also significantly improved. 18.5% of participants used inappropriate medications, with benzodiazepine hypnotics the most common (40.9%). 24.2% of subjects were successfully linked to social resources. The presence of the frail phenotypes exhaustion was significantly associated with an improvement in frail severity (odds ratio (OR) = 2.77, 95% confidence interval (CI) = 1.15–6.66, p = 0.023). There was a significant dose response relationship between the improvement of frail status and physical training times (proportion of improved frail status 23.7%, 40.5% and 47.9% for 0, 1–3, and 4–6 times of physical training, p = 0.03). Conclusion: The reported CGA-based, personalized multidisciplinary intervention model was effective at improving frail severity among pre-frail and frail elderly in OPDs.