Skip to main content
SpringerLink
Log in

Integrated Care for Frail Older People Suffering from Dementia and Multi-morbidity

  • Chapter
  • First Online:
Handbook Integrated Care

  • 2548 Accesses

Abstract

The challenges of care for frail older people with dementia and multi-morbidity are increasing, partly due to our improved health care services and increased life expectancy. This challenge is not an easy one. It requires innovative approaches in order to face these challenges and to reduce current and future burden of service users, their families and society. It is a challenge that requires new care paradigms and new organizational paradigms. Working towards the principles of a new concept of health, working towards personalized and person-centred care in networks, based on shared normative and functional frameworks needs full attention of policy makers and care providing organisations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Alzheimer Nederland, Vilans. (2013). Zorgstandaard Dementie. Utrecht: Alzheimer Nederland, Vilans.

    Google Scholar 

  • Alzheimer’s Association. (2015). What is dementia? Accessed October 14, 2015, from www.alz.org/what-is-dementia.asp

  • Bakker, T. J. E. M. (2010). Integrative reactivitation and rehabilitation to reduce multiple psychiatric symptoms of psychogeriatric patients and caregiver burden. Dissertation, VU University Amsterdam, Amsterdam

    Google Scholar 

  • Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—The pinnacle of patient-centered care. New England Journal of Medicine, 366, 780–781.

    Article  Google Scholar 

  • Boyd, C. M., & Fortin, M. (2010). Future of multimorbidity research: How should understanding of multimorbidity inform health system design? Public Health Reviews, 32(2), 451–474

    Google Scholar 

  • Bunn, F., Burn, A.M., Goodman, C., Rait, G., Norton, S., Robinson, L., Schoeman, J., & Brayne, C. (2014). Comorbidity and dementia: A scoping review of the literature. BMC Medicine, 12, 192. https://doi.org/10.1186/s12916-014-0192-4

  • Castell, M.-V., Sánchez, M., Julia´n, R., Queipo, R., Mart´ın, S., & Otero, A. (2013). Frailty prevalence and slow walking speed in persons age 65 and older: Implications for primary care. BMC Family Practice, 14, 86. https://doi.org/10.1186/1471-2296-14-86

  • Cummings, J., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The neuropsychiatric inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.

    Article  Google Scholar 

  • Davis, S., Byers, S., Nay, R., & Koch, S. (2009). Guiding design of dementia friendly environments in residential care settings: Considering the living experiences. Dementia, 8(2), 185–203. https://doi.org/10.1177/1471301209103250.

    Article  Google Scholar 

  • Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. Journal of Gerontology: Medical Sciences, 59(3), 255–263.

    Google Scholar 

  • Gobbens, R. J. J., Luijkx, K. G., Wijnen-Sponselee, M. T., Schols, J. M.G. A. (2010). Towards an Integral Conceptual Model of Frailty. The Journal of Nutrition, Health & Aging, 14(3), 175–181.

    Google Scholar 

  • Gobbens, R., Luijkx, K., Wijnen-Sponselee, R., Assen, M. v., & Schols, J. (2011). Wetenschappelijke definities en metingen van kwetsbaarheid. In C. v. Campen (Ed.), Kwetsbare ouderen (pp. 39–50). Den Haag: Sociaal en Cultureel Planbureau.

    Google Scholar 

  • Huber, M., Knotnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., et al. (2011). How should we define health? British Medical Journal, BMJ, 343, d4163.

    Google Scholar 

  • Huber, M., van Vliet, M., Giezenberg, M., Winkens, B., Heerkens, Y., Dagnelie, P. C., & Knotnerus, J. A. (2016). Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health: A mixed methods study. British Medical Journal Open, 6, e010091. https://doi.org/10.1136/bmjopen-2015-010091.

    Article  Google Scholar 

  • Inspectie Gezondheidszorg en Jeugd. (2015). Kijken met andere ogen naar de zorg voor mensen met dementie en onbegrepen gedrag. 29–6–2015, Utrecht.

    Google Scholar 

  • Inspectie Gezondheidszorg en Jeugd (2020). Verbetering nodig in zorg voor cliënten met zeer ernstig probleemgedrag bij dementie, 13-1-2020, Utrecht.

    Google Scholar 

  • Larson, E. B., Kristine Yaffe, M. P. H., & Langa, K. M. (2013). New insights into the dementia epidemic. New England Journal of Medicine, 369, 2275–2277. https://doi.org/10.1056/NEJMp1311405

  • Matthews, F. E., Arthur, A., Barnes, L. A., Bond, J., Jagger, C., Robinson, L., & Brayne, C. (2013). A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: Results of the cognitive function and ageing study I and II. The Lancet, 382(9902), 1405–1412.

    Google Scholar 

  • Minkman, M. M. N., Ligthart, S. A., & Huijsman, R. (2009). Integrated dementia care in the Netherlands: A multiple case study of case management programmes. Health and Social Care in the Community, 17(5), 485–494.

    Article  Google Scholar 

  • NICE. (2015). Dementia, disability and frailty in later life—Mid-life approaches to delay or prevent onset. NICE Guidelines [NG16]. Accessed January 7, 2016, from https://www.nice.org.uk/guidance/ng16

  • Nies, H. (2014). Communities as co-producers in integrated care. International Journal of Integrated Care. ISSN 1568-4156.

    Google Scholar 

  • Nies, H. (2016). The journey towards community-based dementia care: The destination, roadmap, guide, tour group and the conditions. Healthcare Papers, 16(2), 57–63. https://doi.org/10.12927/hcpap.2017.25001.

    Article  Google Scholar 

  • Nies, H., Meerveld, J., & Denis, R. (2009). Dementia care: Linear links and networks. Healthcare Papers, 10(1), 34–43.

    Article  Google Scholar 

  • Nies, H., & Minkman, M. (2015). Innovatie in governance. Eigenaarschap van het publieke belang in een participatiesamenleving. In H. Den Uyl, T. van Zonneveld (red.), Zorg voor toezicht. De maatschappelijke betekenis van governance in de zorg (pp. 74–82). Amsterdam: Mediawerf.

    Google Scholar 

  • Nordenfelt, L. (2009). Health, autonomy and quality of life: Some basic concepts in the theory of health care and the care of older people. In L. Nordenfelt (Ed.), Dignity in care for older people (pp. 3–25). Chichester: Wiley.

    Chapter  Google Scholar 

  • OECD. (2015). Addressing dementia: The OECD response. Paris: OECD Health Policy Studies, OECD Publishing.

    Book  Google Scholar 

  • OECD. (2019). Health at a glance 2019: OECD Indicators. OECD Publishing, Paris,. https://doi.org/10.1787/4dd50c09-en.

    Article  Google Scholar 

  • Poblador-Plou, B., Calderón-Larrañaga, A., Marta-Moreno, J., Hancco-Saavedra, J., Sicras-Mainar, A., Soljak, M., & Prados-Torres, A. (2014). Comorbidity of dementia: A cross-sectional study of primary care older patients. BMC Psychiatry, 14, 84. https://doi.org/10.1186/1471-244X-14-84

  • Prince, M., Bryce, R., Albanese, E., Wome, A., Ribeiro, W., & Ferri, C. P. (2013). The global prevalence of dementia: A systematic review and metaanalysis. Alzheimer’s and Dementia, 9(1), 63–75.

    Article  Google Scholar 

  • Puts, M. T. E., Lips, P., & Deeg, D. H. J. (2005). Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. Journal of Clinical Epidemiology, 58, 1188–1198.

    Article  Google Scholar 

  • RIVM. (2020a). Volksgezondheidenzorg.info. https://www.volksgezondheidenzorg.info/onderwerp/dementie/kosten/zorguitgaven#node-zorguitgaven-dementie-naar-sector

  • RIVM. (2020b). Volksgezondheidenzorg.info. https://www.volksgezondheidenzorg.info/onderwerp/chronische-ziekten-en-multimorbiditeit/cijfers-context/huidige-situatie

  • Scharlach, A. E., & Lehning, A. J. (2013). Age-friendly communities and social inclusion in the United States of America. Ageing and Society, 33, 110–136. https://doi.org/10.1017/S0144686X12000578.

    Article  Google Scholar 

  • Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C., & Roland, M. (2009). Defining comorbidity: Implications for understanding health and health services. The Annals of Family Medicine, 7(4), 357–363.

    Article  Google Scholar 

  • Valentijn, P., Schepman, S., Opheij, W., & Bruijnzeels, M. (2013). Understanding integrated care: A comprehensive conceptual framework based on the integrative function of primary care. International Journal of Integrated Care, 13 (Jan–Mar), URN:NBN:NL:UI:10-1-114415.

    Google Scholar 

  • Van Mierlo, L. D., Van der Roest, H. G., Meiland, F. J. M., & Dr€oes, R. M. . (2010). Personalized dementia care: Proven effectiveness of psychosocial interventions in subgroups (review). Ageing Research Reviews, 9, 163–183.

    Article  Google Scholar 

  • Van Mierlo, L. D., Meiland, F. J. M., Van der Roest, H. G., & Dr€oes, R. M. (2012). Personalized caregiver support: Effectiveness of psychosocial interventions in subgroups of caregivers of people with dementia (Review). International Journal of Geriatric Psychiatry, 27, 1–14.

    Google Scholar 

  • Van Maar, C. E., Wijenberg, E., Stapersma, E., & Siegerink, E. (2014). Ketens dementie goed op koers met de Zorgstandaard Dementie als kompas. Utrecht: Vilans.

    Google Scholar 

  • Van Oostrom, S. H., Picavet, H. S. J., van Gelder, B. M., Lemmens, L. C., Hoeymans, N., Verheij, R. A., Schellevis, F. G., & Baan, C. A. (2011). Multimorbiditeit en comorbiditeit in de Nederlandse bevolking—gegevens van huisartsenpraktijken. Nederlands Tijdschrift voor Geneeskunde, 155, A3193.

    Google Scholar 

  • WHO. (2006). Constitution of the World Health Organization. www.who.int/governance/eb/who_constitution_en.pdf

  • World Health Organization. (2015, March). Dementia (Fact sheet No362).

    Google Scholar 

  • Zuidema, S. U., Smalbrugge, M., Bil, W. M. E., Geelen, R., Kok, R. M., Luijendijk, H. J., van der Stelt, I., van Strien, A. M., Vink, M. T., & Vreeken, H. L. (2018). Multidisciplinary guideline problem behaviour in dementia. Verenso, NIP. Utrecht 2018.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vilans, National Centre of Expertise for Long-Term Care, Churchilllaan 11, P.O. Box 8228, Utrecht, 3503 RE, The Netherlands

    Henk Nies & Mirella Minkman

  2. Organization Sciences, Vrije Universiteit, De Boelelaan 1105, De Boelelaan 1101, Amsterdam, 1081 HV, The Netherlands

    Henk Nies

  3. Innovation of the Organization and Governance of Integrated Long Term Care, TIAS School for Business and Society, University of Tilburg, Postbus 90153, Tilburg, 5000 LE, The Netherlands

    Mirella Minkman

  4. Van Maar Advies, Houtwerf 14, 3451 DC, Vleuten, The Netherlands

    Corine van Maar

Authors
  1. Henk Nies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mirella Minkman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corine van Maar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henk Nies .

Editor information

Editors and Affiliations

  1. Institute for Epidemiology, Social Medicine and Health System Research, Medical School Hannover, Hannover, Germany

    Volker Amelung

  2. Leiden University Medical Center, Leiden, The Netherlands

    Viktoria Stein

  3. Faculty of Social Work, University of Calgary, Calgary, AB, Canada

    Esther Suter

  4. University of Newcastle, Gosford, NSW, Australia

    Nicholas Goodwin

  5. Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK

    Ellen Nolte

  6. Innovation Division and Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel

    Ran Balicer

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Nies, H., Minkman, M., van Maar, C. (2021). Integrated Care for Frail Older People Suffering from Dementia and Multi-morbidity. In: Amelung, V., Stein, V., Suter, E., Goodwin, N., Nolte, E., Balicer, R. (eds) Handbook Integrated Care. Springer, Cham. https://doi.org/10.1007/978-3-030-69262-9_41

Download citation

Publish with us

Policies and ethics

Search

Navigation