The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trial

Abstract

BackgroundFrailty among older people is related to an increased risk of adverse health outcomes such as acute and chronic diseases, disability and mortality. Although many intervention studies for frail older people have been reported, only a few have shown positive effects regarding disability prevention. This article presents the design of a two-arm cluster randomized controlled trial on the effectiveness, cost-effectiveness and feasibility of a primary care intervention that combines the most promising elements of disability prevention in community-dwelling frail older people.Methods/designIn this study twelve general practitioner practices were randomly allocated to the intervention group (6 practices) or to the control group (6 practices). Three thousand four hundred ninety-eight screening questionnaires including the Groningen Frailty Indicator (GFI) were sent out to identify frail older people. Based on their GFI score (≥5), 360 participants will be included in the study. The intervention will receive an interdisciplinary primary care intervention. After a comprehensive assessment by a practice nurse and additional assessments by other professionals, if needed, an individual action plan will be defined. The action plan is related to a flexible toolbox of interventions, which will be conducted by an interdisciplinary team. Effects of the intervention, both for the frail older people and their informal caregivers, will be measured after 6, 12 and 24 months using postal questionnaires and telephone interviews. Data for the process evaluation and economic evaluation will be gathered continuously over a 24-month period.DiscussionThe proposed study will provide information about the usefulness of an interdisciplinary primary care intervention. The postal screening procedure was conducted in two cycles between December 2009 and April 2010 and turned out to be a feasible method. The response rate was 79.7%. According to GFI scores 29.3% of the respondents can be considered as frail (GFI ≥ 5). Nearly half of them (48.1%) were willing to participate. The baseline measurements started in January 2010. In February 2010 the first older people were approached by the practice nurse for a comprehensive assessment. Data on the effect, process, and economic evaluation will be available in 2012.Trial RegistrationISRCTN31954692

Care for community‐dwelling frail older people: a practice nurse perspective

“…More detailed information about the care programmes can be found in the articles of Metzelthin et al . () and Stijnen et al . ().…”

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

“…In the ACT trial, the PRISMA-7 questionnaire was used to assess frailty by telephone [5,6]. In the PoC trial, a postal questionnaire was used to identify frail older people: the Groningen Frailty Indicator [7]. The U-PROFIT trial made use of Electronic Medical Records to select older people with frailty [8,9].…”

Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings

“…In the Netherlands, practice nurses (PNs) are involved in disease prevention, chronic care management, mental health services, assessments of older people and care of families with young children (van Weel et al ., ). Three regions, in the southern part of the Netherlands, implemented care programmes in which the PN fulfils a central role (Metzelthin et al ., ; Stijnen et al ., ). The care programmes were implemented in primary‐care practices and aimed at proactively identifying frail older people and detecting health problems – in the physical, psychological and social domains – to prevent further deterioration of health.…”