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

Franca G H Ruikes; Sytse U Zuidema; Reinier P Akkermans; Willem J J Assendelft; Henk J Schers; Raymond T C M Koopmans

doi:10.3122/jabfm.2016.02.150214

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

J Am Board Fam Med. 2016 Mar-Apr;29(2):209-17. doi: 10.3122/jabfm.2016.02.150214.

Authors

Franca G H Ruikes¹, Sytse U Zuidema², Reinier P Akkermans², Willem J J Assendelft², Henk J Schers², Raymond T C M Koopmans²

Affiliations

¹ From the Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen (FGHR, RPA, WJJA, HJS, RTCMK); the Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen (SUZ); and the Joachim and Anna Centre for Specialized Geriatric Care, Nijmegen, the Netherlands (RTCMK). Franca.Ruikes@Radboudumc.nl.
² From the Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen (FGHR, RPA, WJJA, HJS, RTCMK); the Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen (SUZ); and the Joachim and Anna Centre for Specialized Geriatric Care, Nijmegen, the Netherlands (RTCMK).

PMID: 26957377
DOI: 10.3122/jabfm.2016.02.150214

Abstract

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.

Keywords: Aging; Delivery of Health Care; Frail Elderly; Geriatric Assessment; Geriatrics; Interdisciplinary Health Team; Primary Health Care.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aged
Aged, 80 and over
Female
Frail Elderly / statistics & numerical data*
General Practice / methods*
Geriatric Assessment / methods*
Humans
Independent Living / statistics & numerical data
Male
Netherlands / epidemiology
Non-Randomized Controlled Trials as Topic
Primary Health Care / methods*
Quality of Life
Surveys and Questionnaires