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FrailtyNCT00718432

An Interventional Study of Geriatric Frailty, Osteoporosis, and Depression

A study testing Exercise and nutritional integrated care and Problem solving therapy (PST) integrated care in people with Frailty and Osteoporosis, run by National Health Research Institutes, Taiwan at 1 site in Taiwan.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Frailty, osteoporosis, and depression are three highly prevalent geriatric syndromes. Having these conditions are associated with adverse outcome in physical health, mental health, quality of life, and daily functioning. They are associated with higher mortality rates as well as increased health care cost. Read more about this study

Who is it for?
Ages 65 to 79 years
Conditions the study is for
Frailty, Osteoporosis, Depression
What is being tested?
Exercise and nutritional integrated care and Problem solving therapy (PST) integrated care
Could I receive a placebo?
No, everyone receives an active treatment
How many people
406 participants
Where
1 siteTaiwan
Study dates
Apr 2008to Dec 2010
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 65 to 79 years
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • Scored 3-6 with the "Canadian Study of Health and Aging Clinical Frailty Scale (CSHA- CFS) Chinese Telephone Interview Version" (Telephone Interview Version is replaced by In-Person Interview Version in 2009 study)
  • Frailty index ≥ 1

Who cannot join

  • Nursing home residents
  • Cannot speak any of the following three dialogues: Mandarin, Taiwanese and Haga
  • Hearing impairment interfering with communication or daily activities
  • Visual impairment interfering with communication or daily activities.
  • Cannot complete the screening instrument with the CSHA-CFS Chinese Telephone/In-Person Interview Version
  • Scored 1, 2, or 7 with the CSHA-CFS Chinese Telephone/In-Person Interview Version
Show all 11Show fewer
  • Cognitive impairment defined as 3-item recall ≤ 1
  • Functional Impairment defined as not able to walk for 5 meters without assistance
  • Suicidal Ideation defined as Suicide Subscale of The Mini-International Neuropsychiatric Interview (M.I.N.I.) ≥ 6
  • Alcohol abuse disorders active within the last year. (score ≥ 2 on the CAGE)
  • Organic mental disorders (Seizure, brain tumor, brain surgeries), History of schizophrenia or bipolar diagnosed from psychiatrist

Trial locations and contacts

1 site in 1 country.

Taiwan1 site
  • National Health Research Institutes

    Zhunan

Other trials in Taiwan

About this study

Official title: Interventional Study of Geriatric Frailty, Osteoporosis, and Depression in a Community Based Randomized Trial.

Frailty, osteoporosis, and depression are three highly prevalent geriatric syndromes. Having these conditions are associated with adverse outcome in physical health, mental health, quality of life, and daily functioning. They are associated with higher mortality rates as well as increased health care cost. Risk factors, pathogenesis, clinical phenotypes, and interventions of these three geriatric syndromes are often related. Frailty is often defined as accumulations of multi-system deficiencies with increased vulnerability to multiple worse outcomes. Multifactorial, interdisciplinary integrated care models targeting frail older adults may have positive impacts on measurements associated with not only frailty, but also depression, or osteoporosis. The objective of this proposed study is to conduct a randomized control trial (RCT) to exam the effectiveness of integrated interventions on multiple outcomes among community-dwelling Taiwanese elders with high risks for frailty and/or osteoporosis, depression. We also plan to determine the differential effects of intervention between urban and rural area.

Read the detailed description

This is a three-year study. In the first year, we conducted a pilot study to test the feasibility of implementing integrated model on frailty, osteoporosis, depression, and other outcomes. Another objective is to determine optimal sample size for next level intervention in year 2 and 3 (2009 study).

Subjects are community-dwelling Taiwanese elders (65-79 years of age) living in Toufen Town in Miaoli County, Taiwan. Subjects are first screened with telephone interviews with the Chinese Canadian Study of Health and Aging _Clinical Frailty Scale (CCSHA_CFS). Eligible subjects are invited to a community hospital to be screened with the Health Study Phenotypic Classification of Frailty (CHS_PCF). Subjects scored ≥ 1 on the CHS_PCF are enrolled. With a 2 by 2 factorial design, subjects are first randomized into exercise/nutrition integrated care (ENIC) group and usual care (UC) group with education. Within each group, subjects are further randomized into problem solving therapy (PST) and usual care (UC) group with education by study care managers with pre-specified protocol. UC group subject received a study educational booklet with telephone follow up on compliance of booklet reading and suggested diet and exercise programs. Besides the booklets, ENIC group subjects received structured exercise 3 times/week with nutrition consultation as needed at hospital for 3 months while PST group subjects received 6 sessions of PST at hospital in 3 months.

Subjects were followed at 3, 6 and 12 months. Primary outcome is improvement of the CHS_PCF by at least one category (from pre-frail to robust, or from frail to pre-frail or robust) from baseline analysis. Secondary outcomes include the physical function and performance, cognition, depression, quality of life, healthcare resource utilizations and bone-mineral density (BMD). Intention-to-treat analysis was applied.

The pilot study enrolled 117 subjects, after analysis of the preliminary results, the study protocol for the second and third year (2009 study) is modified as follows:

  1. The study is conducted at one urban (Wanhua) and one rural (Toufen) site with roughly 150 participants at each site.
  2. Convenient samples referred from participant physicians' clinics instead of the population based samples in year 1 are used to decrease administration cost.
  3. Telephone based first stage screening instrument will be modified and validated for face to face interview.
  4. Longer intervention period (6-months) than year 1.
  5. Interventions provided in ENIC and PSTIC groups are combined into a single integrated care (IC) group. Interventions for IC group and UC group are minor changed, as described below.

UC group: Inform the subjects about results of frailty, osteoporosis or depression assessment. The study educational booklet and CD-ROM on frailty, depression, osteoporosis, healthy diets, exercise protocols, and self-coping strategies will be given to participants. One 2-hour educational session is provided to participants to go through the booklet with demonstration of study exercise protocol. Subjects are encouraged to have balanced nutrition and regular exercises at home following the study protocol. Subjects were contacted bimonthly to check on how much they had read and watched the study material, and how well they had complied with the suggested diet and exercise protocols. However, it is at the subjects' discretion to discuss with their primary care physicians regarding the clinical interventions.

IC group: Subjects will receive all interventions provided to the UC group. Furthermore, subjects will take exercise/rehabilitation courses at the participating hospitals twice a week for 24 weeks and 6 sessions of problem solving treatment (PST). If subjects do not improve on any of the 5 indicators from the (CHSPCF), comprehensive geriatric assessments (CGAs) are applied to identify more potential modifiable factors for frailty for individualized managements.

Actual number of subjects enrolled in pilot study and 2009 study are 117 and 289 respectively and the total number of subjects enrolled in pilot study and 2009 study is 406.

Being tested
Exercise and nutritional integrated care, Usual care with education, Problem solving therapy (PST) integrated care
Keywords
Frailty, Osteoporosis, Depression
Medical subject headings
Frailty, Osteoporosis, Depression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Exercise and nutritional integrated careBehavioural

    Besides the information sharing and the educational booklets, the ENIC group subjects are invited to take a structured exercise course at the participating hospital 3 times a week for 3 months. (twice a week for 24 weeks in 2009 study) The exercise program included warm up; a range of motion, stretching, and postural-correction activities; aerobic strengthening; balance; and cool down. The research team also inquired about the subjects' dietary compliance and responded to their dietary questions during the exercise sessions.

  • Usual care with educationBehavioural

    The study educational booklet (plus CD-ROM in 2009 study) on frailty, depression, osteoporosis, healthy diets, exercise protocols, and coping strategies are given to the participants. UC group subjects will receive a 2-hour education based on the content of study booklet including 1-hour demonstration of study exercise program in 2009 study. Subjects are contacted monthly (bimonthly in 2009 study ) for frequencies of reading this booklet and the compliance on the suggested diet and exercise protocols. Subjects are also encouraged to follow with their primary care physicians for abnormal results identified from our assessments.

  • Problem solving therapy (PST) integrated careBehavioural

    Besides the information sharing and the educational booklets, the PSTIC group subjects will receive 6 sessions of PST (within 12 weeks in pilot study, within 24 weeks in 2009 study) aiming at solving the 'here-and-now' problems contributing to their mood-related condition and helps increase their self-efficacy. If major depressions are found, subjects are referred to their primary care physicians for further medical managements.

Study groups in NCT00718432
Study groupRoleWhat they receive
UC groupActive comparatorUsual care with education
Receives: Behavioral: Usual care with education
ENIC group (IC group in 2009 study)ExperimentalExercise and nutritional integrated care
Receives: Behavioral: Exercise and nutritional integrated care
PSTIC group (IC group in 2009 study)ExperimentalProblem solving therapy integrated care
Receives: Behavioral: Problem solving therapy (PST) integrated care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. improvement of frailty

    Improvement of Cardiovascular Health Study Phenotypical Classification of Frailty (CHS_PCF) by at least one category (from pre-frail to robust, or from frail to pre-frail or robust) from baseline assessments.

    Measured: baseline, 3, 6, and 12 months

Secondary outcomes (17)
  1. Bone Mineral Density

    Dual-emission X-ray absorptiometry (DXA) of both Hip and spine

    Measured: baseline and 12 months

  2. quality of life assessment

    EQ-5D index-Taiwan utility

    Measured: pilot study: baseline, 3, 6, and 12 months, 2009 study: baseline, 6, and 12 months

  3. QUALEFFO_31

    pain, physical function,mental function

    Measured: pilot study: baseline, 3, 6, and 12 months, 2009 study: baseline, 6, and 12 months

  4. barthel index

    Measured: pilot study: baseline, 3, 6, and 12 months, 2009 study: baseline and 12 months

  5. PRIME-MD (only measured in pilot study)

    The Primary Care Evaluation of Mental Disorders

    Measured: baseline, 3, 6, and 12 months

  6. BDI-II (only measured in 2009 study)

    Beck Depression Inventory Second Edition

    Measured: baseline, 6, and 12 months

  7. health-resource utilization

    Measured: pilot study: baseline, 3, 6, and 12 months, 2009 study: baseline, 6, and 12 months

  8. Original Frailty Indicators

    Weight loss, Exhaustion, Low level physical activity, Slow walking speed, Weak grip strength

    Measured: baseline, 3, 6, and 12 months

  9. timed up and go

    Measured: baseline, 3, 6, and 12 months

  10. one leg stand time

    Measured: baseline, 3, 6, and 12 months

  11. dominant hand grip strength

    Measured: baseline, 3, 6, and 12 months

  12. dominant knee extension power

    Measured: baseline, 3, 6, and 12 months

  13. vitamin B12 in blood

    Measured: pilot study: baseline and 12 month, 2009 study: baseline and 6 months

  14. vitamin D in blood

    Measured: pilot study: baseline and 12 month, 2009 study: baseline and 6 months

  15. CRP in blood

    Measured: pilot study: baseline and 12 month, 2009 study: baseline and 6 months

  16. testosterone in blood

    Measured: pilot study: baseline and 12 month, 2009 study: baseline and 6 months

  17. IL-6 in blood

    Measured: pilot study: baseline and 12 month, 2009 study: baseline and 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Jul 2008 (estimated)
  2. Study startApr 2008
  3. Primary completionJun 2010
  4. Study completionDec 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Factorial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
406 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00718432
Sponsor's protocol ID
EC0970301
Status last verified
Jun 2009
First submitted
16 Jul 2008
Last updated
25 Jun 2015
Results posted
No
Data monitoring committee
Yes

Publications

  • Chan DC, Tsou HH, Yang RS, Tsauo JY, Chen CY, Hsiung CA, Kuo KN. A pilot randomized controlled trial to improve geriatric frailty. BMC Geriatr. 2012 Sep 25;12:58. doi: 10.1186/1471-2318-12-58.

    PubMed 23009149

Questions about this trial

What is this clinical trial studying?

A study testing Exercise and nutritional integrated care and Problem solving therapy (PST) integrated care in people with Frailty and Osteoporosis, run by National Health Research Institutes, Taiwan at 1 site in Taiwan.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Jun 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

improvement of frailty (time frame: baseline, 3, 6, and 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00718432, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jun 2015.

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