A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study).
BACKGROUND
The effectiveness of community-based geriatric intervention models for vulnerable older adults is controversial. We evaluated a problem-based multidisciplinary intervention targeting vulnerable older adults at home that promised efficacy through better timing and increased commitment of patients and primary care physicians. This study compared the effects of this new model to usual care.


METHODS
Primary care physicians referred older people for problems with cognition, nutrition, behavior, mood, or mobility. One hundred fifty-one participants (mean age 82.2 years, 74.8% women) were included in a pseudocluster randomized trial with 6-month follow-up for the primary outcomes. Eighty-five participants received the new intervention, and 66 usual care. In the intervention arm, geriatric nurses visited patients at home for geriatric assessment and management in cooperation with primary care physicians and geriatricians. Modified intention-to-treat analyses focused on differences between treatment arms in functional abilities (Groningen Activity Restriction Scale-3) and mental well-being (subscale mental health Medical Outcomes Study [MOS]-20), using a mixed linear model.


RESULTS
After 3 months, treatment arms showed significant differences in favor of the new intervention. Functional abilities improved 2.2 points (95% confidence interval [CI], 0.3-4.2) and well-being 5.8 points (95% CI, 0.1-11.4). After 6 months, the favorable effect increased for well-being (9.1; 95% CI, 2.4-15.9), but the effect on functional abilities was no longer significant (1.6; 95% CI, -0.7 to 3.9).


CONCLUSIONS
This problem-based geriatric intervention improved functional abilities and mental well-being of vulnerable older people. Problem-based interventions can increase the effectiveness of primary care for this population.
Melis
René J F
RJ
Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine, Nijmegen, The Netherlands. r.melis@ger.umcn.nl
van Eijken
Monique I J
MI
Teerenstra
Steven
S
van Achterberg
Theo
T
Parker
Stuart G
SG
Borm
George F
GF
van de Lisdonk
Eloy H
EH
Wensing
Michel
M
Rikkert
Marcel G M Olde
MG
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D005853:Geriatrics / Q000379:methods; D006299:Health Services for the Aged / Q000592:standards*; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008962:Models, Theoretical; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D013577:Syndrome