134 Evaluation of the Community Rehabilitation Inpatient Specialist Program (CRISP)—an advanced nurse practitioner (RANP)-led program for frail older adults

• Published in: Age and ageing Vol. 52; no. Supplement_3
• Main Authors: Doyle, M, Mathew, J, Morris, E, Ryan, D, McDonagh, R
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 14.09.2023; Oxford Publishing Limited (England)
• Subjects: Access; Activities of daily living; Acute services; Advanced nurse practitioners; Balance; Barthel Index; Caregivers; Cohort analysis; Community health care; Community living; Early intervention; Frail; Geriatric assessment; Geriatrics; Health promotion; Inpatient care; Interdisciplinary aspects; Mobility; Neurology; Nurse led care; Older people; Outpatient clinics; Patient admissions; Quality of life; Rehabilitation; Statistical analysis; Stress; Stress management
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afad156.011

Abstract Background Frail older adults disproportionately access acute healthcare services. Novel integrated care programs are needed to redesign care delivery focusing on community-based health promotion, as opposed to crisis response. CRISP is a bespoke, RANP-led program that provides direct access for community-dwelling older adults to short-term (2-weeks) in-patient intensive multidisciplinary rehabilitation based on a Comprehensive Geriatric Assessment. Referrals are received from Geriatric ED services, geriatric/neurology/rehabilitation medicine outpatient clinics, ICPOP and local GPs. Admission to a Model 2 Age- Related rehabilitation centre occurs within 4–8 weeks of referral. Methods This Prospective cohort study examines the short to medium-term effects of the CRISP program. Functional, mobility and Quality-of-Life (QoL) measures were collected on admission and discharge. Fall rates, QoL and carer stress are measured four months after completion of the program. Data were analysed using Microsoft Excel. Functional outcome and QoL measurements were compared using paired t-test. Results 73 patients (78%) completed the program and attended for follow up (2021–2022), average age: 80.9 yrs, SD-6.6 yrs, frailty index 5.6 (mild to moderate frailty). There have been statistically significant gains made in performance in activities of daily living (Barthel Index; 76.7A vs 83.9 DC) (p < 0.001), balance (Berg Balance Scale:29.6A vs 36.3 DC) (p < 0.001 and QOL (EQ5D:45.2 A vs 69.8 DC) (p < 0.001). CRISP delivers long-term positive benefits including reduction in falls rates: 2.9(4 months pre-admission) vs 0.5 (4 months following completion of the program) (p < 0.001) and improvement in self-reported QoL, EQ5D:45.2 A vs 62.6 at 4 months following completion of the program. Carers who reported stress 62% (n-45), 91% reported a reduction in stress levels 4 months following the program. Conclusion CRISP provides early intervention at the lowest level of care complexity resulting in reduced fall rates and consequent crisis presentations to acute care. CRISP improves mobility and function promoting independence and improving QoL for community dwelling older adults.