Abstract
BackgroundBecause of their complex clinical presentations and needs frail elderly people require another approach than people who age without many complications. Several inpatient geriatric health services have proven effectiveness in frail persons. However, the wish to live independently and policies that promote independent living as an answer to population aging call for community intervention models for frail elderly people. Maybe models such as preventive home visits, comprehensive geriatric assessment, and intermediate care qualify, but their efficacy is controversial, especially in frail elderly persons living in the community. With the Dutch EASYcare Study Geriatric Intervention Programme (DGIP) we developed a model to study effectiveness of problem based community intervention models in frail elderly people.Methods/DesignDGIP is a community intervention model for frail elderly persons where the GP refers elderly patients with a problem in cognition, mood, behaviour, mobility, and nutrition. A geriatric specialist nurse applies a guideline-based intervention with a limited number of follow up visits. The intervention starts with the application of the EASYcare instrument for geriatric screening. The EASYcare instrument assesses (instrumental) activities of daily life, cognition, mood, and includes a goal setting item. During the intervention the nurse regularly consults the referring GP and a geriatrician. Effects on functional performance (Groningen Activity Restriction Scale), health related quality of life (MOS-20), and carer burden (Zarit Burden Interview) are studied in an observer blinded randomised controlled trial. 151 participants were randomised over two treatment arms – DGIP and regular care – using pseudo cluster randomisation. We are currently performing the follow up visits. These visits are planned three and six months after inclusion. Process measures and cost measures will be recorded. Intention to treat analyses will focus on post intervention differences between treatment groups.DiscussionThe design of a trial evaluating the effects of a community intervention model for frail elderly people was presented. The problem-based participant selection procedure satisfied; few patients that the GP referred did not meet our eligibility criteria. The use of standard terminology makes detailed insight into the contents of our intervention possible using terminology others can understand well.
Highlights
Because of their complex clinical presentations and needs frail elderly people require another approach than people who age without many complications
The design of a trial evaluating the effects of a community intervention model for frail elderly people was presented
Intervention should take the heterogeneity of the population into account; because of their complex clinical presentations and needs frail persons require another approach than people who age without many complications [3]
Summary
Because of their complex clinical presentations and needs frail elderly people require another approach than people who age without many complications. People prefer to stay at home, even with considerable disability [5] Another drive behind the development of community intervention models comes from policies that promote independent living as an answer to the questions raised by population aging [6]. Models such as preventive home visits, in home comprehensive geriatric assessment, and intermediate care provide effective health services for frail older people in the community. Both the definition and efficacy of these community intervention models remain subject of a vivid debate [7,8,9,10]. GARS-3 [27] Timed up and go test [44] MOS-20 [26] Subscale mental health MOS-20 Cantril self-anchoring ladder [45] Dementia Quality of Life questionnaire [46] question general life satisfaction MMSE [25] Loneliness scale de Jong-Gierveld [47] √√√
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