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Related Concept Videos

Documentation in Long-Term and Home Healthcare Setting01:29

Documentation in Long-Term and Home Healthcare Setting

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Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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An interdisciplinary team includes many healthcare professionals working together and utilizing their skills, knowledge, and expertise to provide holistic and quality patient care.
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Rural Health Centers
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Specialized care provided over an extended period is called tertiary care. Usually, a primary or secondary care physician will refer a patient to tertiary care. A patient's maximum physical and mental function is restored in tertiary care, which is caused due to the impact of a chronic illness or condition. Tertiary care aims to achieve the highest level of functioning possible while managing chronic illness. For example, a patient who falls and fractures their hip will need secondary care...
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Related Experiment Video

Updated: Jul 10, 2025

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
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Geriatric Services Hub - A Collaborative Frailty Management Model between The Hospital and Community Providers.

L F Tan1, J Teng, Z J Chew

  • 1Li Feng Tan, Alexandra Health Pte Ltd: National Healthcare Group, Singapore, Singapore, E-Mail: tanlifeng@gmail.com; li_feng_tan@nuhs.edu.sg.

The Journal of Frailty & Aging
|November 27, 2023
PubMed
Summary
This summary is machine-generated.

A novel Geriatric Service Hub (GSH) in Singapore identified high rates of frailty, sarcopenia, and fear of falling in community-dwelling older adults. This model shows promise for effective, population-level frailty management.

Keywords:
Frailtycommunity carecomprehensive geriatric assessmentmulti-disciplinary team care

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Area of Science:

  • Geriatric Medicine
  • Public Health
  • Community Care Models

Background:

  • Frailty is a significant geriatric syndrome, particularly in aging populations.
  • Community-based interventions by multidisciplinary teams can manage or reverse frailty.
  • Innovative, context-specific community frailty models are needed for cost-effective care.

Purpose of the Study:

  • To pilot and evaluate the Geriatric Service Hub (GSH), a novel community-based frailty care model in Singapore.
  • To identify and manage frailty in community-dwelling older adults using a hospital-supported multidisciplinary team.
  • To share preliminary data on the GSH model's implementation and outcomes.

Main Methods:

  • Retrospective analysis of patient data from the GSH program (January 2020 - May 2021).
  • Detailed description of the GSH model and its implementation process.
  • Assessment of patient characteristics, frailty/sarcopenia prevalence, and intervention referral rates.

Main Results:

  • 152 individuals participated; 59.9% were female, mean age 81.0 ± 7.1 years.
  • High prevalence of frailty (31.6% vulnerable, 51.3% mildly frail), sarcopenia (45.3%), and fear of falling (56.9%).
  • High referral rates for physiotherapy (87.5%), occupational therapy (71.1%), and dietetics (50.7%).

Conclusions:

  • The GSH model effectively partners with community providers for population-level frailty screening.
  • The study highlights high, previously unrecognized rates of frailty, sarcopenia, and fear of falling in community-dwelling older adults.
  • This model offers a feasible approach to comprehensive frailty care for pre-frail and frail older adults.