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Randomized Controlled Trial
. 2016 Jul 26;11(7):e0158714.
doi: 10.1371/journal.pone.0158714. eCollection 2016.

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

Jacqueline J Suijker  1 , Marjon van Rijn  2 , Bianca M Buurman  2 , Gerben Ter Riet  1 , Eric P Moll van Charante  1 , Sophia E de Rooij  2   3
Affiliations
Randomized Controlled Trial

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

Jacqueline J Suijker et al. PLoS One. .

Abstract

Background: To evaluate the effects of nurse-led multifactorial care to prevent disability in community-living older people.

Methods: In 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.

Results: At 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.

Conclusions: We 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 registration: Netherlands Trial Register NTR2653.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow of practices and participants through the trial.
Numbers do not add up because persons who did not return a questionnaire at 6 months (n = 119) could return a questionnaire at 12, 18 and/or 24 months. Eleven practices were randomized to the intervention group and 13 practices were randomized to the control group. In both groups around 35% of the invited persons were at increased risk of functional decline and participated in the study. In both groups the follow-up rates were around 77% and 76% after one and two years respectively.
Fig 2
Fig 2. Effect of the intervention on disability (modified Katz-ADL index score).
The effect of the intervention was equal (-0.07) and very small across all follow-up times; The scale on the y-axis only ranges from 0 to 7.0 points on the modified Katz-ADL index score, which is a 15-point scale.
Fig 3
Fig 3. Effect of the intervention on secondary outcomes.
The effect of the intervention was small and statistically not significant for all secondary outcomes across all follow-up moments except for after-hours primary care were a small effect was found at six months. Note that the scales on the y-axis do not cover the full range of the measurement instrument.
Fig 4
Fig 4. Kaplan Meier all-cause mortality for persons at increased risk of functional decline.
No difference was found in overall mortality between both study arms; Log rank test = 0.84; p = 0.36.
See this image and copyright information in PMC

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