Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial

Rimmele, Martina; Wirth, Jenny; Britting, Sabine; Gehr, Thomas Johann; Hermann, Margit; Heuvel, Dirk van den; Kestler, Andreas; Koch, Thomas; Schoeffski, Oliver; Volkert, Dorothee; Wingenfeld, Katja; Wurm, Susanne; Freiberger, Ellen; Sieber, Cornel

doi:10.1136/bmjopen-2020-037999

Cited by 10 publications

(14 citation statements)

References 44 publications

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“…Patient inclusion criteria were a minimum age of 75 years, a Mini Mental State Score of more than 22. Exclusion criteria were a palliative status, and a planned hospital readmission within the next 4 weeks [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate

et al. 2021

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Background An increasing number of older people in Germany receive care at home from family members, particularly from spouses. Family care has been associated not only with subjective burden but also with negative effects on caregivers’ health. A heterogeneous group, caregivers are confronted with individual situational demands and use different available coping strategies. To date, little is known about the relationship between burden and coping by spousal caregivers, particularly in the context of geriatric patients without dementia. Objectives The aim of this study is to explore the burden and coping strategies of caregiving spouses of geriatric patients without dementia and with a hospitalization within the last year. To help explore this population, a typology is presented that has been based on reported perceptions of home care burden and individual coping strategies. Furthermore, a case study is presented for each type of spousal caregiver. Methods The study used a concurrent mixed method design with a sample of nine spousal caregivers (mean age: 78.9 years). Four women and five men were recruited in an acute hospital setting during the TIGER study. Quantitative data were collected using a self-questionnaire and qualitative data were gathered through nine problem-centered interviews with spousal caregivers. The latter were subsequently analyzed utilizing the structured content analysis method. The data were then summarized to nine individual cases. Finally, the results were clustered using the empirically grounded construction of types and typologies. Each type of spousal caregiver is presented by a case study. Results Three types of caregiving spouses were identified: “The Caring Partner”, “The Worried Manager” and “The Desperate Overburdened”. These types differ primarily in the level of subjective burden and caregiving stress, the coping strategies, the motivation for caregiving, and expressed emotions. Conclusions The development of this new typology of caregiving spouses could help health care professionals better understand caregiving arrangements and thus provide more targeted advice. Trial registration The TIGER study was registered with clinicaltrials.gov: NCT03513159. Registered on April 17, 2018.

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Section: Methodsmentioning

confidence: 99%

A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate

et al. 2021

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“…This study is a secondary analysis of the project TIGER (Transsectoral Intervention Program for Improvement of Geriatric Care in Regensburg), which was a 12-month non-blinded randomized controlled trial with two arms. The study was carried out from April 2018 until June 2020 in St John of God hospital (Barmherzige Brüder) in the city of Regensburg and its surrounding area in Germany, and is described in detail elsewhere [ 20 ]. The study was registered in ClinicalTrials.gov (Identifier: NCT03513159) and its study protocol was approved by the ethics committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) on 5 March 2018 (# 60- 18B).…”

Section: Methodsmentioning

confidence: 99%

“…This study is a secondary analysis of the project TIGER (Transsectoral Intervention Program for Improvement of Geriatric Care in Regensburg), which was a 12-month nonblinded randomized controlled trial with two arms. The study was carried out from April 2018 until June 2020 in St John of God hospital (Barmherzige Brüder) in the city of Regensburg and its surrounding area in Germany, and is described in detail elsewhere [20].…”

Section: Trail Design Registration and Ethical Approvementmentioning

confidence: 99%

“…The intervention was designed based on the Transitional Care Model [18,20]. Pathfinders, in collaboration with patients, family members, and care team (e.g., family physicians, hospital care and discharge planning team, ambulant care services) developed a comprehensive individualized care plan for IG patients.…”

Section: Interventionmentioning

confidence: 99%

“…Based on TCM [ 18 ], a randomized controlled trial was conducted in Germany to improve the care transition from hospital to home for geriatrics patients [ 20 ]. The study aimed to achieve a reduction in hospital readmission rate by improving older patients’ care, including improvement of their nutritional situation at home after hospital discharge through a comprehensive individualized care plan by geriatric-experienced care professionals.…”

Section: Introductionmentioning

confidence: 99%

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Does a 12-Month Transitional Care Model Intervention by Geriatric-Experienced Care Professionals Improve Nutritional Status of Older Patients after Hospital Discharge? A Randomized Controlled Trial

et al. 2021

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At hospital discharge, many older patients are at health and nutritional risk, indicating a requirement for ongoing care. We aim to evaluate the effects of comprehensive individualized care by geriatric-experienced care professionals, the so-called “pathfinders”, on nutritional status (NS) of older patients after discharge. A total of 244 patients (median age 81.0 years) without major cognitive impairment were randomized to Intervention Group (IG: 123) or Control Group (CG: 121) for a 12-month intervention, with up to 7 home visits and 11 phone calls. The comprehensive individualized care contained nutritional advice, when required. The intervention effect after three (T3m) and 12 (T12m) months on change in MNA-SF (Mini Nutritional Assessment-Short Form) and BMI was evaluated by Univariate General Linear Model (ANOVA), adjusted for age, sex, living situation, and activities of daily living. At baseline, mean MNA-SF did not differ between IG and CG (10.7 ± 2.6 vs. 11.2 ± 2.5, p = 0.148); however, mean BMI was significantly lower in IG compared to CG (27.2 ± 4.7 vs. 28.8 ± 4.8 kg/m2, p = 0.012). At T3m, mean change did not differ significantly between the groups, neither in MNA-SF (0.6; 95%CI: −0.1–1.3 vs. 0.4; −0.3–1.1, p = 0.708) nor in BMI (−0.2; −0.6–0.1 vs. 0.0; −0.4–0.4 kg/m2, p = 0.290). At T12m, mean change of MNA-SF was significantly higher in IG than in CG (1.4; 0.5–2.3 vs. 0.0; −0.9–0.8; p = 0.012). BMI remained unchanged in IG, whereas it slightly declined in CG (0.0; −0.7–0.6 vs. −0.9; −1.6– −0.2 kg/m2, p = 0.034). We observed rather small effects of comprehensive individualized care by pathfinders on NS in older patients 12 months after discharge. For more pronounced effects nutrition expertise might be needed.

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Intersektoralität im Fokus – Strategien und aktuelle Forschungsprojekte zur Versorgung geriatrischer Personen

Unterkofler,

Hertwig,

Bollheimer

et al. 2024

Bundesgesundheitsbl

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ZusammenfassungIn Anbetracht des demografischen Wandels wurde bereits die Notwendigkeit zur intersektoralen Versorgung der alternden Bevölkerung identifiziert. Die Strategien zur Umsetzung sind vielfältig und setzen an verschiedenen Hebeln an, die jeweils unterschiedliche Sektorenüberschneidungen voraussetzen. Der Artikel bietet einen Überblick über bereits abgeschlossene und noch laufende Projekte zur Versorgung geriatrischer Patienten. Dabei wird deutlich: Der Aufbau von Netzwerken als unverzichtbare Basis für Intersektoralität kann nicht in direkten Interventionseffekten messbar gemacht werden und erschwert somit den Kosten-Nutzen-Nachweis. Ebenso zeigt sich, dass einige Forschungsprojekte bei der Überführung in die Regelversorgung durch finanzielle und personelle Engpässe scheitern.Brauchen wir in Deutschland ein Umdenken oder weniger innovationsbezogene Förderlinien zur besseren Implementierung und Erforschung bereits existierender Konzepte? Internationale Vorbilder wie Japan machen klar: Die Kostenreduktion bei der Versorgung der alternden Bevölkerung sollte langfristig betrachtet werden und bedarf kurzfristig erhöhter Finanzvolumina. Für eine nachhaltige Implementierung von sektorenübergreifenden Ansätzen im Alltag sollte deshalb die Versorgungsforschung fest(gefahren)e Strukturen, Abläufe und Finanzierungen neu ordnen. Durch Verknüpfung der unzähligen Projekte und Ideen verschiedener Bereiche könnte in Zukunft eine Realisierung des Anspruchs der intersektoralen Versorgung geriatrischer Patienten erreicht werden.

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Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial

Cited by 10 publications

References 44 publications

A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate

A typology of caregiving spouses of geriatric patients without dementia: caring, worried, desperate

Does a 12-Month Transitional Care Model Intervention by Geriatric-Experienced Care Professionals Improve Nutritional Status of Older Patients after Hospital Discharge? A Randomized Controlled Trial

Intersektoralität im Fokus – Strategien und aktuelle Forschungsprojekte zur Versorgung geriatrischer Personen

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