Opening the Black Box of Integrated Care: The underlying mechanisms of integrated care delivery to hospitalized elderly

Abstract

The rapid increase in the prevalence of multiple chronic diseases in older people has irrevocably altered medical care. Previous studies have shown that between 65% and 88% of those aged 65 years or older suffer from more than one chronic disease (Hoffman, Rice, & Sung, 1997; Wolff, Starfield, & Anderson, 2002). These older patients suffer from a mixture of problems in multiple life domains, concerning not only physical health, but also social and psychological well-being (Rowe & Kahn, 1997). Hospitalisation is a risk for this vulnerable group of patients: about 35% of people aged 70 and over admitted to the hospital function less well after discharge than before their admission. This percentage increases with age (Covinsky et al., 2003). Once admitted to the hospital, older patients are at an increased risk of poor outcomes such as readmission, increased length of stay, iatrogenic complications, and nursing home placement (Forster, Murff, Peterson, Gandhi, & Bates, 2003; Palmer, 1998). As a result, hospitalisation is often followed by a decline in the ability to perform activities of daily living (Sager et al., 1996; Wu et al., 2000). To retain their ability to cope and their quality of life, it is necessary to prevent loss of function among older patients. Since only 20% of these losses in function are related to hospital diagnosis (Covinsky et al., 2003), one of the most important starting points to prevent function loss among older patients is encapsulated in care delivery itself.