title: Effects of Nurse-Led Multifactorial Care to Prevent Disability in Community-Living Older People: Cluster Randomized Trial.
abstract: BACKGROUND
  To evaluate the effects of nurse-led multifactorial care to prevent disability in community-living older people.
  
  
  METHODS
  In a cluster randomized trail, 11 practices (n = 1,209 participants) were randomized to the intervention group, and 13 practices (n = 1,074 participants) were randomized to the control group. Participants aged ≥ 70 years were at increased risk of functional decline based on a score ≥ 2 points on the Identification of Seniors at Risk- Primary Care, ISAR-PC. Participants in the intervention group received a systematic comprehensive geriatric assessment, and individually tailored multifactorial interventions coordinated by a trained community-care registered nurse (CCRN) with multiple follow-up home visits. The primary outcome was the participant's disability as measured by the modified Katz activities of daily living (ADL) index score (range 0-15) at one year follow-up. Secondary outcomes were health-related quality of life, hospitalization, and mortality.
  
  
  RESULTS
  At baseline, the median age was 82.7 years (IQR 77.0-87.1), the median modified Katz-ADL index score was 2 (IQR 1-5) points in the intervention group and 3 (IQR 1-5) points in the control group. The follow-up rate was 76.8% (n = 1753) after one year and was similar in both trial groups. The adjusted intervention effect on disability was -0.07 (95% confidence interval -0.22 to 0.07; p = 0.33). No intervention effects were found for the secondary outcomes.
  
  
  CONCLUSIONS
  We found no evidence that a one-year individualized multifactorial intervention program with nurse-led care coordination was better than the current primary care in community-living older people at increased risk of functional decline in The Netherlands.
  
  
  BACKGROUND
  Netherlands Trial Register NTR2653.
authors.affiliation: Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Suijker
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marjon
authors.initials: M
authors.lastname: van Rijn
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Buurman
authors.affiliation: Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Gerben
authors.initials: G
authors.lastname: Ter Riet
authors.affiliation: Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Moll van Charante
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.|University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D019983:Guideline Adherence; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D009426:Netherlands; D009732:Nursing Care; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012923:Social Class