A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study).

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Publication year
2008Source
Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 63, 3, (2008), pp. 283-90ISSN
Publication type
Article / Letter to editor

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Organization
IQ Healthcare
Geriatrics
Health Evidence
Primary and Community Care
Former Organization
Centre for Quality of Care Research
Epidemiology, Biostatistics & HTA
Journal title
Journals of Gerontology Series A-Biological Sciences and Medical Sciences
Volume
vol. 63
Issue
iss. 3
Page start
p. 283
Page end
p. 90
Subject
DCN 1: Perception and Action; EBP 2: Effective Hospital Care; EBP 3: Effective Primary Care and Public Health; EBP 4: Quality of Care; IGMD 5: Health aging / healthy living; NCEBP 11: Alzheimer Centre; NCEBP 14: Cardiovascular diseases; NCEBP 2: Evaluation of complex medical interventions; NCEBP 4: Quality of hospital and integrated care; NCEBP 6:Quality of nursing and allied health care; NCEBP 9: Mental health; ONCOL 4: Quality of CareAbstract
BACKGROUND: The effectiveness of community-based geriatric intervention models for vulnerable older adults is controversial. We evaluated a problem-based multidisciplinary intervention targeting vulnerable older adults at home that promised efficacy through better timing and increased commitment of patients and primary care physicians. This study compared the effects of this new model to usual care. METHODS: Primary care physicians referred older people for problems with cognition, nutrition, behavior, mood, or mobility. One hundred fifty-one participants (mean age 82.2 years, 74.8% women) were included in a pseudocluster randomized trial with 6-month follow-up for the primary outcomes. Eighty-five participants received the new intervention, and 66 usual care. In the intervention arm, geriatric nurses visited patients at home for geriatric assessment and management in cooperation with primary care physicians and geriatricians. Modified intention-to-treat analyses focused on differences between treatment arms in functional abilities (Groningen Activity Restriction Scale-3) and mental well-being (subscale mental health Medical Outcomes Study [MOS]-20), using a mixed linear model. RESULTS: After 3 months, treatment arms showed significant differences in favor of the new intervention. Functional abilities improved 2.2 points (95% confidence interval [CI], 0.3-4.2) and well-being 5.8 points (95% CI, 0.1-11.4). After 6 months, the favorable effect increased for well-being (9.1; 95% CI, 2.4-15.9), but the effect on functional abilities was no longer significant (1.6; 95% CI, -0.7 to 3.9). CONCLUSIONS: This problem-based geriatric intervention improved functional abilities and mental well-being of vulnerable older people. Problem-based interventions can increase the effectiveness of primary care for this population.
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- Faculty of Medical Sciences [86198]
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