Care for older people in Dutch general practice: Results from the FIT study

With the aging population, the increase of multimorbidity, and growing strain on limited resources, the need to prevent or postpone new disabilities in later life has become ever more urgent. This thesis focuses on nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people. First, we developed an instrument to identify older persons at increased risk of functional decline in primary healthcare (Identification of Seniors at Risk- Primary Care (ISAR-PC)). ISAR-PC contains three items: IADL dependence, self-reported memory complaints, and age and appeared to have moderate discrimination and was well calibrated. Second, we developed a multifactorial intervention for the most prevalent geriatric conditions based on all available evidence in primary care, to evaluate the (cost-) effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities. We found no evidence that a one-year nurse-led multifactorial intervention was better than current primary care to prevent or postpone new disabilities and was not cost-effective in community-living older people at increased risk of functional decline in the Netherlands. Third, applying CGA in community-living older persons with an increased risk of functional decline yielded many geriatric conditions, yet resulted in low recognition rates of these geriatric conditions. Despite the lack of evidence for beneficial effects on the prevention of new disabilities, the implementation of proactive integrated care programs is ongoing in many healthcare systems throughout the Western world. Further research is needed to evaluate such programs with regard to quality of life, quality of care and costs.