Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

F. G. H. Ruikes, S. U. Zuidema, R. P. Akkermans, W. J. J. Assendelft, H. J. Schers, R. T. C. M. Koopmans
<span title="2016-03-01">2016</span> <i title="American Board of Family Medicine (ABFM)"> <a target="_blank" rel="noopener" href="" style="color: black;">Journal of the American Board of Family Medicine</a> </i> &nbsp;
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 twostep older persons
more &raquo; ... g 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. (J Am Board Fam Med 2016;29:209 -217.) Population aging has a profound effect on the number of frail elders and is a major challenge for health care systems. Frailty is a condition in which losses in several domains of functioning lead to a declin-ing reserve capacity and a subsequently increased vulnerability in functional decline, dependence, hospitalization, institutionalization, and death. 1-3 It is thought to be present in up to a quarter of people This article was externally peer reviewed.
<span class="external-identifiers"> <a target="_blank" rel="external noopener noreferrer" href="">doi:10.3122/jabfm.2016.02.150214</a> <a target="_blank" rel="external noopener" href="">pmid:26957377</a> <a target="_blank" rel="external noopener" href="">fatcat:yo53iafrxnh35ddovy6j6r3lwu</a> </span>
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