Effects of home telemonitoring on transitions between frailty states and death for older adults: a randomized controlled trial
Benjavan Upatising,1 Gregory J Hanson,2 Young L Kim,3 Stephen S Cha,4 Yuehwern Yih,1 Paul Y Takahashi2
1School of Industrial Engineering, Purdue University, West Lafayette, IN, USA; 2Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; 3School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA; 4Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
Background: Two primary objectives when caring for older adults are to slow the decline to a worsened frailty state and to prevent disability. Telemedicine may be one method of improving care in this population. We conducted a secondary analysis of the Tele-ERA study to evaluate the effect of home telemonitoring in reducing the rate of deterioration into a frailty state and death in older adults with comorbid health problems.
Methods: This trial involved 205 adults over the age of 60 years with a high risk of hospitalization and emergency department visits. For 12 months, the intervention group received usual medical care and telemonitoring case management, and the control group received usual care alone. The primary outcome was frailty, which was based on five criteria, ie, weight loss, weakness, exhaustion, low activity, and slow gait speed. Participants were classified as frail if they met three or more criteria; prefrail if they met 1–2 criteria; and not frail if they met no criteria. Both groups were assessed for frailty at baseline, and at 6 and 12 months. Frailty transition analyses were performed using a multiple logistic regression method. Kaplan–Meier and Cox proportional hazards methods were used to evaluate each frailty criteria for mortality and to compute unadjusted hazard ratios associated with being telemonitored, respectively. A retrospective power analysis was computed.
Results: During the first 6 months, 19 (25%) telemonitoring participants declined in frailty status or died, compared with 17 (19%) in usual care (odds ratio 1.41, 95% confidence interval [CI] 0.65–3.06, P = 0.38). In the subsequent 6 months, there was no transition to a frailty state, but seven (7%) participants from the telemonitoring and one (1%) from usual care group died (odds ratio 5.94, 95% CI 0.52–68.48, P = 0.15). Gait speed (hazards ratio 3.49, 95% CI 1.42–8.58) and low activity (hazards ratio 3.10, 95% CI 1.25–7.71) were shown to predict mortality.
Conclusion: This study did not provide sufficient evidence to show that the telemonitoring group did better than usual care in reducing the decline of frailty states and death. Transitions occurred primarily in the first 6 months.
Keywords: telemedicine, high-risk elderly persons, frailty transition, functional decline
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