Anticipatory care planning for community-dwelling older adults at risk of functional decline: a feasibility cluster randomized controlled trial

• Published in: BMC geriatrics 2022-05, Vol.22 (1), p.452-452, Article 452
• Main Authors: Brazil, Kevin, Cardwell, Christopher, Carter, Gillian, Clarke, Mike, Corry, Dagmar Anna S, Fahey, Tom, Gillespie, Patrick, Hobbins, Anna, McGlade, Kieran, O'Halloran, Peter, O'Neill, Nina, Wallace, Emma, Doyle, Frank
• Format: Article
• Language: English
• Subjects: Advance care planning; Aged; Analysis; Anticipatory care planning; Costs; Dementia; Elder care; Feasibility Studies; Feasibility study; Frailty; Functional decline; Geriatrics; Health care; Health Personnel; Health risks; Humans; Independent Living; Integrated delivery systems; Intervention; Medical care; Medical care, Cost of; Methods; Nurses; Older people; Patient assessment; Patient care planning; Patient-centered care; Patients; Planning; Primary care; Primary health care; Quality of Life; Services; Social interactions; United Kingdom - epidemiology; Utilization
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-022-03128-x

To determine the feasibility, implementation and outcomes of an Anticipatory Care Planning (ACP) intervention in primary care to assist older adults at risk of functional decline by developing a personalized support plan. Feasibility cluster randomized control trial. Eight primary care practices (four in Northern Ireland, United Kingdom and four in the Republic of Ireland) were randomly assigned to either intervention or control arm. Eligible patients were those identified in each practice as 70 years of age or older and assessed as at risk of functional decline. Study participants (intervention n = 34, control n = 31) and research staff were not blinded to group assignment. The intervention delivered by a registered nurse including: a) a home-based patient assessment; b) care planning on the basis of a holistic patient assessment, and c) documentation of a support plan. A conceptual framework (RE-AIM) guided the assessment on the potential impact of the ACP intervention on patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and reduction of potentially inappropriate prescribing. Data were collected at baseline and at 10 weeks and six months following delivery of the intervention. All pre-specified feasibility indicators were met. Patients were unanimous in the acceptance of the ACP intervention. Health care providers viewed the ACP intervention as feasible to implement in routine clinical practice with attending community supports. While there were no significant differences on the primary outcomes (EQ-5D-5L: -0.07 (-0.17, 0.04) p = .180; CES-D: 1.2 (-2.5, 4.8) p = .468) and most secondary measures, ancillary analysis on social support showed responsiveness to the intervention. Incremental cost analysis revealed a mean reduction in costs of €320 per patient (95% CI -31 to 25; p = 0.82) for intervention relative to the control. We successfully tested the ACP intervention in primary care settings and have shown that it is feasible to implement. The ACP intervention deserves further testing in a definitive trial to determine whether its implementation would lead to better outcomes or reduced costs. Clinicaltrials.gov, ID: NCT03902743 . Registered on 4 April 2019.