TIGER (Taiwan)

Taiwan Integrated Geriatric Care (TIGER)

This project examined the effects on physical and mental capacity of a community-based integrated care service model among older adults with multiple chronic conditions. Although the capacity levels increased for both the intervention and control group, the intervention group showed greater overall improvement, including less likelihood of being cognitively impaired.

Latest page update: 27 October, 2025

Aim of the project

To examine the effectiveness of incorporating multidomain lifestyle interventions into primary care on physical and mental health benefits as well as quality of life.

Location

Six sites in Taiwan in Hualien Tzu Chi, New Taipei City and Yilan.

Hualien Tzu Chi Hospital
Shulin Primary care Center
Yingge Primary Health Care center
Tang’s primary care clinic
National Yang-Ming University Hospital
Taipei Veterans General Hospital Yuanshan Branch

Local setting

The TIGER study enrolled community-dwelling outpatients aged ≥65 years with at least three chronic conditions from six sites across Taiwan, including Taipei, New Taipei City, Yilan, and Hualien.

Organizations involved

National Yang Ming Chiao Tung University

Principal Investigator (PI)

Liang-Kung Chen, National Yang Ming Chiao Tung University

Research team

Chi-Hung Lin, Department of Health, New Taipei City Government
Shinn-Zong Lin, Buddhist Tzu Chi Medical Foundation Hualien Tzu Chi Hospital
Wei-Ju Lee, Taipei Veterans General Hospital, YuanShan branch
Chun-Feng Huang, National Yang-Ming University Hospital
Chia-Yun Chang, Shulin Primary Care Center, Department of Health, New Taipei City Government
Tzu-Shing Hung, Yingge Primary Care Center, Department of Health, New Taipei City Government
Ting-Ching Tang, Tang’s Orthopedic & Otolaryngological Clinics

Duration of the intervention

12 months

Project start date

2018

Project end date

2020

Current stage of the project

Complete

Number of study participants

398

Target population

Community dwelling older adults aged 65 years or older with at least three chronic medical conditions

Outcomes

Primary outcomes

Change in Quality of life based on SF-36 scores

Secondary outcome

Set of health outcomes proposed by the International Consortium of Health Outcomes Measurements (ICHOM))

Exploratory outcomes

Changes in blood biomarkers such as lipid profile, fasting glucose, uric acid, vitamin D & B12, homocysteine, etc.
Cognitive performance, using MoCA

Intervention

Participants were randomized to two groups:

Multidomain intervention
Usual care

Integrated Multidomain intervention
Domains

Physical exercise
Cognitive training
Nutritional advice
Disease management education plus individualized treatment by specialists in integrated geriatric care

Results

Summary: Compared with usual care, the integrated multidomain intervention significantly improved on the SF-36 physical component score and several subdomains, and the overall value-based metric score, with significantly higher likelihood of completing advance care planning and lower likelihood of limited instrumental activities of daily living, pain, and slowness. The integrated multidomain intervention also showed lower levels of cognitive impairment.

Primary outcomes

When looking at both groups at 12 months, they showed improvement for the physical component scores and mental component scores of the SF-36.
The integrated multidomain intervention group improved slightly more than the usual care arm in the SF-36 physical component score, but when analysing the differences between the groups in changes in score, then this did not reach significance.
When looking at the SF-36 mental component scores at 12 months, the integrated multidomain intervention group improved slightly more compared to the usual care group, nonetheless when analysing the differences between groups in changes in score, these were not statistically significant.

Secondary outcomes

When looking at both groups at 12 months, the integrated multidomain intervention group had significantly higher mean ICHOM value-based metric scores (overall difference 0.2, 95% CI 0.1–0.3; p=0.0031), indicating a significant improvement in overall quality and value of care.
When looking at advance care planning, participants in the integrated multidomain intervention group were more likely to have completed it compared with those receiving usual care (odds ratio 1.40, 95% CI 1.04–1.88; p = 0.028).
When looking at functional outcomes, the integrated multidomain intervention group had significantly lower odds of limited instrumental activities of daily living (0.73, 0.58–0.93; p=0.011) and lower odds of slowness (0.81, 0.66–1.00; p=0.045).

Others

When looking at cognitive outcomes, participants in the integrated multidomain intervention group were less likely to experience cognitive impairment. They showed notable overall improvements across several MoCA domains (p=0.0003 for naming and p<0.0001 for concentration, language, abstract thinking, delayed recall, and orientation).

Acknowledgements

This study was supported by the National Health Research Institutes, Taiwan (NHRI-107A1-PHCO-04181803), and the Ministry of Science and Technology, Taiwan (MOST-108–2634-F-010–001).