Effects of Nurse-Led Multifactorial Care to Prevent Disability in Community-Living Older People: Cluster Randomized Trial

Abstract

BackgroundTo evaluate the effects of nurse-led multifactorial care to prevent disability in community-living older people.MethodsIn 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.ResultsAt 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.ConclusionsWe 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.Trial RegistrationNetherlands Trial Register NTR2653

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

“…Information provided about the exact content of the instrument varied between CGAs. For five CGA instruments, the content of the CGA was available in (the appendix of) the original study or in a study cited in the original study (Buurman et al, ; Buurman, Parlevliet, van Deelen, de Haan, & de Rooij, ; Fleischer et al, ; Ruikes et al, , ; Stijnen, Duimel‐Peeters, et al, ; Suijker et al, , ). For the other CGAs, the original study did not provide or only partially provided the exact content of the CGA nor referred to other papers describing this information.…”

“…Three CGA instruments were tested for their validity and reliability (De Stampa et al, ; Ruikes et al, , ; Van Hout et al, ; Vedel et al, ). For four CGAs, it was explicitly indicated that the instrument was tested for its feasibility (Daniels et al, ; Metzelthin, van Rossum, de Witte, Hendriks, & Kempen, ; Metzelthin et al, ; Ruikes et al, , ; Stijnen, Duimel‐Peeters, et al, ; Suijker et al, , ). For nine CGAs, the average duration of conducting the assessment was described, which ranged from 30 min to 3 hr.…”

“…Examples of domains that were less frequently covered were abuse signs (e.g. physical or emotional abuse; Kono et al, ; Van Hout et al, ), finances (Fleischer et al, ; Suijker et al, , ), and providing informal care (Stijnen, Duimel‐Peeters, et al, ). In addition to addressing different life domains, some CGAs included a section in which concerns, priorities and goals of the older person and the informal carer were explicitly assessed.…”

“…Furthermore, domains were defined in different ways in CGAs. For example, in some CGAs, cognitive functioning was part of the psychological/mental domain (Kono et al, ; Stijnen, Duimel‐Peeters, et al, ; Suijker et al, , ), while in other CGAs, cognition was a domain separate from the psychological/mental domain (Boult et al, ; Boyd et al, ; Ruikes et al, , ).…”

“…In two of these programs, the care plan was only implemented after final approval by the older person (Looman, Fabbricotti, & Huijsman, ; Looman et al, ; Spoorenberg et al, , ; Uittenbroek et al, ). In seven programs, older people were responsible for implementing activities and recommendations that were established in the care plan (Boult et al, ; Bouman, Van Rossum, Ambergen, Kempen, & Knipschild, ; Boyd et al, ; Faul et al, ; Fleischer et al, ; Ploeg et al, ; Rogerson et al, ; Suijker et al, , ).…”