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

Franca G H Ruikes1, Sytse U Zuidema2, Reinier P Akkermans2

  • 1From 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.

Journal of the American Board of Family Medicine : JABFM
|March 10, 2016
PubMed
Summary

A multicomponent primary care program for frail elderly did not prevent functional decline or improve outcomes. Large-scale implementation of this integrated care model is not recommended for community-dwelling older adults.

Keywords:
AgingDelivery of Health CareFrail ElderlyGeriatric AssessmentGeriatricsInterdisciplinary Health TeamPrimary Health Care

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Area of Science:

  • Gerontology
  • Primary Care
  • Public Health

Background:

  • The growing population of frail elderly individuals presents significant challenges for general practice.
  • Evaluating interventions to prevent functional decline in this demographic is crucial.

Purpose of the Study:

  • To assess the effectiveness of a general practitioner-led, multicomponent program for frail elderly individuals.
  • The program aimed to integrate cure, care, and welfare to prevent functional decline.

Main Methods:

  • A cluster-controlled trial was conducted in 12 general practices involving community-dwelling frail elderly aged 70 years and older.
  • The intervention group received a primary care program including proactive care planning, case management, and multidisciplinary team meetings.
  • The control group received usual care, with outcomes assessed at baseline and 12 months.

Main Results:

  • No significant differences were observed between the intervention and control groups regarding independence in functioning (Katz-15 index).
  • Secondary outcomes, including quality of life (EQ5D+C), mental health, social functioning, institutionalization, hospitalization, and mortality, also showed no between-group differences.
  • The study achieved good participant retention, with 71.1% in the intervention group and 66.3% in the control group completing the 12-month follow-up.

Conclusions:

  • The evaluated multifaceted integrated care program demonstrated no effectiveness in preventing adverse outcomes in community-dwelling frail elderly.
  • Based on these findings, large-scale implementation of this specific integrated care program is not advocated.
  • Further research may be needed to identify effective strategies for supporting frail elderly populations in primary care settings.