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Author
M. van Rijn
Title
Nurse-led multifactorial care in community-dwelling older people
Subtitle
Outcomes on daily functioning, experiences and costs
Supervisors
S.E.J.A. de Rooij
Co-supervisors
B.M. Buurman
E.P. Moll van Charante
Award date
13 October 2017
Number of pages
183
ISBN
9789082738308
Document type
PhD thesis
Faculty
Faculty of Medicine (AMC-UvA)
Abstract
The overall aim of this thesis was to improve primary care for community-dwelling older people in the Netherlands. First, by studying the effectiveness of multifactorial care on health and daily functioning of community-dwelling older people, second by exploring the value of the multifactorial care by investigating experiences of older people with this nurse-led multifactorial care, and third by assessing per capita healthcare costs of older people. We evaluated the effects of nurse-led multifactorial care in a cluster randomized controlled trial. 11 practices (n=1,209 participants) were randomized to the intervention group, 13 practices (n=1,074 participants) were randomized to the control group. We found no evidence that a one-year individualized multifactorial intervention program with nurse-led care coordination resulted in prevention or postponement of new disabilities in community-dwelling older people at increased risk of functional decline. One explanation might be that by conducting a comprehensive geriatric assessment many geriatric conditions were detected, yet resulted in low recognition rates of these geriatric conditions by older people themselves. Nevertheless, older people appreciated nurse-led multifactorial care, especially because of the feeling of being looked after. Hospitalization costs were the most important contributor to the overall healthcare costs of older people. Especially older people who encounter functional decline had the highest healthcare costs. Further studies should focus on shared decision making and collaboration with older people to improve overall quality of care.
Permalink
http://hdl.handle.net/11245.1/6bba2919-f384-4ec9-a9cc-90fbb06f8a60
Downloads
  • Thesis (complete) (Embargo up to and including 13 October 2019)

  • Front matter

  • Chapter 1: General introduction

  • Chapter 2: Effects of nurse-led multifactorial care to prevent disability in community-living older people: Cluster randomised trial

  • Chapter 3: Do multiple chronic conditions influence personal views on the ageing process? A qualitative analysis (Embargo up to and including 13 October 2019)

  • Chapter 4: Comprehensive geriatric assessment: recognition of identified geriatric conditions by communitydwelling older persons

  • Chapter 5: Community-dwelling older peoples’ experiences with nurse-led comprehensive geriatric assessment and care coordination (Embargo up to and including 13 October 2019)

  • Chapter 6: Minimal important change and minimal detectable change in activities of daily living in communityliving older people

  • Chapter 7: Transitions in functional disability and associated healthcare costs in community-dwelling older people (Embargo up to and including 13 October 2019)

  • Chapter 8: Changes in the in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients: Retrospective observational study

  • Chapter 9: General discussion

  • Back matter

  • Stellingen

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