RT Journal Article
SR Electronic
T1 Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 209
OP 217
DO 10.3122/jabfm.2016.02.150214
VO 29
IS 2
A1 Ruikes, Franca G.H.
A1 Zuidema, Sytse U.
A1 Akkermans, Reinier P.
A1 Assendelft, Willem J.J.
A1 Schers, Henk J.
A1 Koopmans, Raymond T.C.M.
YR 2016
UL http://www.jabfm.org/content/29/2/209.abstract
AB Background: The increasing number of community-dwelling frail elderly people poses a challenge to general practice. We evaluated the effectiveness of a general practitioner–led extensive, multicomponent program integrating cure, care, and welfare for the prevention of functional decline.Methods: We performed a cluster controlled trial in 12 general practices in Nijmegen, the Netherlands. Community-dwelling frail elderly people aged ≥70 years were identified with the EASY-Care two-step older persons screening instrument. In 6 general practices, 287 frail elderly received care according to the CareWell primary care program. This consisted of proactive care planning, case management, medication reviews, and multidisciplinary team meetings with a general practitioner, practice and/or community nurse, elderly care physician, and social worker. In another 6 general practices, 249 participants received care as usual. The primary outcome was independence in functioning during (instrumental) activities of daily living (Katz-15 index). Secondary outcomes were quality of life [EuroQol (EQ5D+C) instrument], mental health and health-related social functioning (36-item RAND Short Form survey instrument), institutionalization, hospitalization, and mortality. Outcomes were assessed at baseline and at 12 months, and were analyzed with linear mixed-model analyses.Results: A total of 204 participants (71.1%) in the intervention group and 165 participants (66.3%) in the control group completed the study. No differences between groups regarding independence in functioning and secondary outcomes were found.Conclusion: We found no evidence for the effectiveness of a multifaceted integrated care program in the prevention of adverse outcomes in community-dwelling frail elderly people. Large-scale implementation of this program is not advocated.