Prevention of Functional Decline among Hospitalized Older People

Abstract

This thesis describes the results of the evaluation of the Prevention and Reactivation Care Program (PReCaP). The PReCaP is aimed at preventing functional decline among hospitalized older patients and consists of early identification of older patients at risk of functional decline; and intensive follow up treatment in the hospital and if necessary in a specific rehabilitation setting after discharge The PReCaP uses individualized, multidisciplinary integrated geriatric care and geriatric case management from hospital admission up to six months after hospital discharge.

The ISAR-HP, a simple questionnaire consisting of four questions can be used at hospital admission to identify older patients at risk of problems in physical and cognitive functioning, loneliness, lower health-related quality of life, death and higher costs of care at three and twelve months after hospital admission. The PReCaP did not significantly improve independence in activities of daily living and instrumental activities of daily living compared to usual care. Four possible explanations are 1) problems in development, identification and reproducing complex interventions in general; 2) local variations in context, population and elements of care on which the intervention was based; 3) the dynamics of physical functioning; 4) the difficulty of distinguishing hospital-related functional decline from general functional decline among older patients.

Future evaluations of similar complex interventions among hospitalized older people should focus on the medical diagnosis in combination with reactivation domains of specific patient groups at higher risk, such as cardiovascular patients, and might be more successful when implemented in specialized geriatric units.