***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To assess whether an intervention based on nurse home visits including alert buttons ( NV+AB ) is effective in reducing frailty compared to nurse home visits alone ( NV-only ) and usual care ( control group ) for older adults . Design Unblinded , r and omized , controlled trial . Setting Insured population covered by the Mexican Social Security Institute living in the city of Ensenada , Baja California , Mexico . Participants Patients were aged over 60 years with a frailty index score higher than 0.14 . Intervention After screening and informed consent , participants were allocated r and omly to the control , NV+AB , or NV-only groups . Measurements The primary outcome was the frailty score 9 months later . Quality of life , depression , comorbidities , health status , and health service utilization were also considered . Results The framing sample included 819 patients . Of those , 591 were not located because they did not have a l and line/telephone ( 341 patients ) , they had died ( 107 ) , they were ill ( 50 ) , or they were not currently living in the city ( 28 ) . A screening interview was applied to 228 participants , and 57 had a score ≤0.14 , 171 had ≥0.14 , and 16 refused to complete the baseline question naire . A home visit was scheduled for 155 patients . However , 22 did not complete the baseline question naire . The final 133 subjects were r and omized into the NV+AB ( n = 45 ) , NV-only ( n = 44 ) , and control ( n = 44 ) groups . There were no statistically significant differences in the baseline characteristics of the groups . The mean age overall was 76.3 years ( st and ard deviation 4.7 ) and 45 % were men . At the baseline , 61.65 % were classified as frail . At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3 % versus 58.3 % in the control group . Conclusion : An intervention based on NV+AB seems to have a positive effect on frailty scores BACKGROUND Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults . We evaluated the impact of the Geriatric Care Model ( GCM ) on the quality of life of community-dwelling frail older adults . METHODS A 24-month stepped wedge cluster r and omized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practice s in the Netherl and s , and included 1147 frail older adults . The intervention consisted of a geriatric in-home assessment by a practice nurse , followed by a tailored care plan . Re assessment occurred every six months . Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams . Complex patients were review ed in multidisciplinary consultations . The primary outcome was quality of life ( SF-12 ) . Secondary outcomes were health-related quality of life , functional limitations , self-rated health , psychological wellbeing , social functioning and hospitalizations . RESULTS Intention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes . Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18months ( B=-0.25 , 95%CI=-0.43 to -0.06 , p=0.007 ) , but this effect was not statistically significant after correction for multiple comparisons . CONCLUSION The GCM did not show beneficial effects on quality of life in frail older adults in primary care , compared to usual care . This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population . TRIAL REGISTRATION The Netherl and s National Trial Register NTR2160 BACKGROUND The aim of this r and omized controlled trial was to determine the effects on functional parameters of an up date d preventive home visit program for frail older adults in the Japanese Long-term Care Insurance ( LTCI ) system . METHODS The program included home visits by nurses or care managers every 3 months for 24 months , with a systematic assessment of care needs to prevent functional decline . Eligible participants ( N = 360 ) were r and omly assigned to the visit ( VG : n = 179 ) or control group ( CG : n = 181 ) .  Functional parameters were gathered via mail question naires at baseline and at 12- and 24-month follow-ups . Care-need levels in the LTCI were obtained at 12- , 24- , and 36-month follow-ups and the utilization of the LTCI service through 36 months . RESULTS Participants in VG were significantly more likely to maintain their activities of daily living ( ADL ) functioning ( p = .0113 ) and less likely to increase care-needs level , compared with CG participants , over 24 months . A generalized linear model showed that the estimate of the effect on increase in care-needs level ( ie , functional decline ) was -0.53 ( p = .042 ) over 36 months . CONCLUSIONS These results suggest that the up date d preventive home visit program could be effective for the prevention of ADL and care-needs deterioration , and these effects could continue up to 1 year after program completion Background Case management has been applied in community aged care to meet frail older people ’s holistic needs and promote cost-effectiveness . This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes . Methods We search ed Web of Science , Scopus , Medline , CINAHL ( EBSCO ) and PsycINFO ( CSA ) from inception to 2011 July . Inclusion criteria were : no restriction on date , English language , community-dwelling older people and /or carers , case management in community aged care , published in refereed journals , r and omized control trials ( RCTs ) or comparative observational studies , examining client or carer outcomes . Quality of studies was assessed by using such indicators as quality control , r and omization , comparability , follow-up rate , dropout , blinding assessors , and intention-to-treat analysis . Two review ers independently screened potentially relevant studies , extracted information and assessed study quality . A narrative summary of findings were presented . Results Ten RCTs and five comparative observational studies were identified . One RCT was rated high quality . Client outcomes included mortality ( 7 studies ) , physical or cognitive functioning ( 6 studies ) , medical conditions ( 2 studies ) , behavioral problems ( 2 studies ) , unmet service needs ( 3 studies ) , psychological health or well-being ( 7 studies ) , and satisfaction with care ( 4 studies ) , while carer outcomes included stress or burden ( 6 studies ) , satisfaction with care ( 2 studies ) , psychological health or well-being ( 5 studies ) , and social consequences ( such as social support and relationships with clients ) ( 2 studies ) . Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group , while all the three studies consistently reported fewer unmet service needs among the intervention participants . In contrast , available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden . There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above . Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs . Future studies should investigate what specific components of case management are crucial in improving clients and their carers ’ outcomes BACKGROUND frail older people have a high risk of  falling . OBJECTIVE assess the effect of a frailty intervention on risk factors for falls and fall rates  in frail older people . DESIGN r and omised controlled trial . PARTICIPANTS 241 community-dwelling people aged 70 + without severe cognitive impairment who met the Cardiovascular Health Study frailty definition . INTERVENTION multifactorial , interdisciplinary intervention targeting frailty characteristics with an individualised home exercise programme prescribed in 10 home visits from a physiotherapist and interdisciplinary management of medical , psychological and social problems . MEASUREMENTS risk factors for falls were measured using the Physiological Profile Assessment ( PPA ) and mobility measures at 12 months by a blinded assessor . Falls were monitored with calendars . RESULTS participants had a mean ( SD ) age of 83.3 ( 5.9 ) years , 68 % were women and 216 ( 90 % ) completed the study . After 12 months the intervention group had significantly better performance than the control group , after controlling for baseline values , in the PPA components of quadriceps strength ( between-group difference 1.84 kg , 95 % CI 0.17 - 3.51 , P = 0.03 ) and body sway ( -90.63 mm , 95 % CI -168.6 to -12.6 , P = 0.02 ) , short physical performance battery ( 1.58 , 95 % CI 1.02 - 2.14 , P ≤ 0.001 ) and 4 m walk ( 0.06 m/s 95 % CI 0.01 - 0.10 , P = 0.02 ) with a trend toward a better total PPA score ( -0.40 , 95 % CI -0.83 - 0.04 , P = 0.07 ) but no difference in fall rates ( incidence rate ratio 1.12 , 95 % CI 0.78 - 1.63 , P = 0.53 ) . CONCLUSION the intervention improved performance on risk factors for falls but did not reduce the rate of falls . TRIAL REGISTRATION ACTRN12608000250336 Objective To evaluate whether an interdisciplinary primary care approach for community dwelling frail older people is more effective than usual care in reducing disability and preventing ( further ) functional decline . Design Cluster r and omised controlled trial . Setting 12 general practice s in the south of the Netherl and s Participants 346 frail older people ( score ≥5 on Groningen Frailty Indicator ) were included ; 270 ( 78 % ) completed the study . Interventions General practice s were r and omised to the intervention or control group . Practice s in the control group delivered care as usual . Practice s in the intervention group implemented the “ Prevention of Care ” ( PoC ) approach , in which frail older people received a multidimensional assessment and interdisciplinary care based on a tailor made treatment plan and regular evaluation and follow-up . Main outcome measures The primary outcome was disability , assessed at 24 months by means of the Groningen Activity Restriction Scale . Secondary outcomes were depressive symptomatology , social support interactions , fear of falling , and social participation . Outcomes were measured at baseline and at 6 , 12 , and 24 months ’ follow-up . Results 193 older people in the intervention group ( six practice s ) received the PoC approach ; 153 older people in the control group ( six practice s ) received care as usual  . Follow-up rates for patients were 91 % ( n=316 ) at six months , 86 % ( n=298 ) at 12 months , and 78 % ( n=270 ) at 24 months . Mixed model multilevel analyses showed no significant differences between the two groups with regard to disability ( primary outcome ) and secondary outcomes . Pre-planned subgroup analyses confirmed these results . Conclusions This study found no evidence for the effectiveness of the PoC approach . The study contributes to the emerging body of evidence that community based care in frail older people is a challenging task . More research in this field is needed . Trial registration Current Controlled Trials IS RCT N31954692 Background Interventions that enhance mobility in frail older people are needed to maintain health and independence , yet definitive evidence of effective interventions is lacking . Our objective was to assess the impact of a multifactorial intervention on mobility-related disability in frail older people . Methods We conducted a r and omised , controlled trial with 241 frail community-dwelling older people in Sydney , Australia . Participants were classified as frail using the Cardiovascular Health Study definition , did not have severe cognitive impairment and were recently discharged from an aged care and rehabilitation service . The experimental group received a 12 month multifactorial , interdisciplinary intervention targeting identified frailty components . Two physiotherapists delivered a home exercise program targeting mobility , and coordinated management of psychological and medical conditions with other health professionals . The control group received usual care .  Disability in the mobility domain was measured at baseline and at 3 and 12 months using the International Classification of Functioning , Disability and Health framework . Participation ( involvement in life situations ) was assessed using the Life Space Assessment and the Goal Attainment Scale . Activity ( execution of mobility tasks ) was measured using the 4-metre walk and self-report measures . Results The mean age of participants was 83.3 years ( SD : 5.9 years ) . Of the participants recruited , 216 ( 90 % ) were followed-up at 12 months . At this time point , the intervention group had significantly better scores than the control group on the Goal Attainment Scale ( odds ratio 2.1 ; 95 % confidence interval ( CI ) 1.3 to 3.3 , P = 0.004 ) and Life Space Assessment ( 4.68 points , 95 % CI 1.4 to 9.9 , P = 0.005 ) . There was no difference between groups on the global measure of participation or satisfaction with ability to get out of the house . At the activity level , the intervention group walked 0.05 m/s faster over 4 m ( 95 % CI 0.0004 to 0.1 , P = 0.048 ) than the control group , and scored higher on the Activity Measure 
    Output:
    
Conclusion This systematic review and meta- analysis does not provide sufficient scientific evidence that interventions by frail older adults can be protective against the included adverse outcomes .