title: Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Franca G H
authors.initials: FG
authors.lastname: Ruikes
authors.affiliation: 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).
authors.forename: Sytse U
authors.initials: SU
authors.lastname: Zuidema
authors.affiliation: 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).
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.affiliation: 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).
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.affiliation: 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).
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
authors.affiliation: 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).
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D058006:General Practice / Q000379:methods*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D065228:Non-Randomized Controlled Trials as Topic; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Aging; Delivery of Health Care; Frail Elderly; Geriatric Assessment; Geriatrics; Interdisciplinary Health Team; Primary Health Care