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
2016 Journal of the American Board of Family Medicine  
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 » ... der 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. (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.
doi:10.3122/jabfm.2016.02.150214 pmid:26957377 fatcat:yo53iafrxnh35ddovy6j6r3lwu