Metzelthin SF, van Rossum E, de Witte LP, et al.

BMJ 2013;347:f5264.

Publication date: September 12, 2013


In this cluster randomized controlled trial, the authors randomly allocated 12 general practices in the Netherlands to a “Prevention of Care” approach or usual care for the management of frail community-dwelling older patients. The primary outcome measure was disability at 24 months according to the Groningen Activity Restriction Scale. In the intervention group, frail older persons (screened by means of the Groningen Frailty Indicator) received a multidimensional assessment and interdisciplinary care based on an individualized treatment plan and regular evaluation and follow-up.

A total of 346 frail older persons were enrolled in the study, 56% of whom received the “Prevention of Care” approach. Individuals in the intervention group were significantly frailer and more disabled. At 24 months’ follow-up no significant difference between the two groups with regard to disability was observed. Several limitations of the study may have contributed to this negative result. The lack of effectiveness of the “Prevention of Care” approach also highlight the fact that community-based care in frail older persons is a challenging task.

More research is needed to optimize the effectiveness of community-based interventions for frail older persons.

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