Multicomponent program to reduce functional decline in frail elderly people: A cluster controlled trial

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 twostep 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. conclusion: 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.