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Updated: Feb 16, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview
Linda C Smit1, Marieke J Schuurmans2, Jeanet W Blom3
1Research Group for the Chronically Ill and Elderly, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht 3584 CS, The Netherlands.
Objectives:
Complex interventions are criticized for being a "black box", which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions.
Study Design And Setting:
A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands.
Results:
There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists.
Conclusions:
An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions.
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