Secondary outcomes will be : physical performance ( chair stand ) , nutritional status ( weight , Body Mass Index and hand-grip strength ) , oral care , fall incidents , hospital admissions , rehabilitation stay , moving to nursing homes ( for participants from home-care ) , use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary support.Furthermore , interviews with nursing home and home-care management , nursing staff and nutrition coordinators in both the control and intervention groups , participants in the intervention group and the involved multidisciplinary team will be performed .