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Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel

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Tijdschrift voor Gerontologie en Geriatrie

Integrated approach to prevent functional decline in hospitalized elderly

Background

Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age.

Methods/design

To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented the Prevention and Reactivation Care Programme (PReCaP), an innovative program aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline.

Discussion

This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the prevention and Reactivation Centre; (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of forthcoming papers.

This article is an edited translation of the previously published article ‘Integrated approach to prevent functional decline in hospitalized elderly: the Prevention and Reactivation Care Program (PReCaP), BMC Geriatrics 2012;12:7, AJBM de Vos, KJE Asmus-Szepesi, TJEM Bakker, PL de Vreede, JDH van Wijngaarden, EW Steyerberg, JP Mackenbach, AP Nieboer.

Samenvatting

Achtergrond

Ziekenhuisgerelateerd functieverlies bij oudere patiënten is een onderschat probleem. Vijfendertig procent van de 70-jarige patiënten ondervindt functieverlies tijdens een ziekenhuisopname in vergelijking met de situatie vóór de ziekte. Dit percentage stijgt aanzienlijk met de leeftijd.

Methoden/opzet

Om dit probleem aan te pakken heeft het Vlietland Ziekenhuis in Nederland het Zorgprogramma voor Preventie en Herstel (ZPH) geïmplementeerd, een innovatief programma gericht op het verminderen van ziekenhuisgerelateerd functieverlies onder oudere patiënten. Het programma biedt multidisciplinaire, geïntegreerde en doelgerichte interventies op de fysieke, sociale, en psychologische domeinen van functieverlies.

Discussie

Dit artikel presenteert een gedetailleerde beschrijving van het ZPH, inclusief de vijf kenmerkende elementen: (1) Vroegtijdige opsporing van oudere patiënten met verhoogd risico op functieverlies, en indien noodzakelijk gevolgd door inzet van reactiverende behandeling binnen 48 uur na ziekenhuisopname; (2) Intensieve nabehandeling voor een selecte patiëntengroep in een Centrum voor Preventie en Herstel; (3) Beschikbaarheid van multidisciplinaire geriatrie-expertise; (4) Begeleiding en ondersteuning van mantelzorgers door relevante professionals; (5) Intensieve nazorg in de gehele zorgketen gecoördineerd door een casemanager met geriatrie-expertise. De resultaten van de effect- en procesevaluatie worden gepubliceerd in een serie toekomstige artikelen.

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Literatuur

  1. Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, et al. Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age. J Am Geriatr Soc 2003;51(4):451-458.

    Article  PubMed  Google Scholar 

  2. Creditor MC. Hazards of Hospitalization of the Elderly. Ann Intern Med 1993;118(3):219-223.

    Article  CAS  PubMed  Google Scholar 

  3. Hoogerduijn JG, Schuurmans MJ, Duijnstee MS, de Rooij SE, Grypdonck MF. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. J Clin Nurs 2007;16:46-57.

    Article  PubMed  Google Scholar 

  4. Bakker TJ, Duivenvoorden HJ, van der Lee J, Krulder JW, Driesen JJ, Ribbe MW. (Prevalence and prognostic importance of riskfactors for long hospital stay within elderly patients admitted to a hospital; a clinical-empirical study). Tijdschrift voor Gerontologie en Geriatrie 2010;41(4):177-86.

    Article  CAS  PubMed  Google Scholar 

  5. Boyd CM, Landefeld CS, Counsell SR, Palmer RM, Fortinsky RH, Kresevic D. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc 2008;56:2171-2179.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hoogerduijn JG, Schuurmans MJ, Korevaar JC, Buurman BM, de Rooij SE. Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments. Journal of Clinical Nursing 2010;19(9-10):1219-25. Epub 2010 Mar 16.

  7. Hebert R, Brayne C, Spiegelhalter D. Factors associated with functional decline and improvement in a very elderly community-dwelling population. American Journal of Epidemiology 1999;150(5):501-10.

    Article  CAS  PubMed  Google Scholar 

  8. Inouye SK. Delirium in older persons. New England Journal of Medicine 2006;354:1157-1165.

    Article  CAS  PubMed  Google Scholar 

  9. Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM. The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in older hospitalized patients. Journal of the American Geriatrics Society 2000;48(12):1697-1706.

    CAS  PubMed  Google Scholar 

  10. Inouye SK, Baker DI, Fugal P, Bradley EH. Dissemination of the Hospital Elder Life Program: Implementation, Adaptation, and Successes. J Am Geriatr Soc 2006;54(10):1492-1499.

    Article  PubMed  Google Scholar 

  11. Hirsch CH, Sommers L, Olsen A, Mullen L, Winograd CH. The natural history of functional morbidity in hospitalized older patients. Journal of the American Geriatrics Society 1990;38(12):1296-303.

    CAS  PubMed  Google Scholar 

  12. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. Journal of the American Medical Association 2002;287(8):1022-8.

    PubMed  Google Scholar 

  13. de Morton NA, Keating JL, Jeffs K. The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials. Clinical Rehabilitation 2007;21(1):3-16.

    Article  PubMed  Google Scholar 

  14. Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, et al. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: A randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc 2000 DEC;48(12):1572-1581.

  15. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, et al. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 2008;371(9614):725-35.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Asplund K, Gustafson Y, Jacobsson C, Bucht G, Wahlin A, Peterson J, et al. Geriatric-based versus general wards for older acute medical patients: A randomized comparison of outcomes and use of resources. J Am Geriatr Soc 2000 NOV;48(11):1381-1388.

  17. Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull 2005;71:45-59.

    Article  PubMed  Google Scholar 

  18. Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez-Artalejo F. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. British Medical Journal 2009;338(b50).

  19. Van Craen K, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P, et al. The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc. 2010;58(1):83-92. Epub 2009 Dec 9.

  20. Gillespie L.D., Gillespie WJ, Robertson, M,C, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database of Systematic Reviews 2003(4).

  21. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department? The DEED II study. J Am Geriatr Soc 2004;52(9):1417-1423.

    Article  PubMed  Google Scholar 

  22. Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. Journal of the American Medical Association 1999;281(7):613-20.

    Article  CAS  PubMed  Google Scholar 

  23. Cunliffe AL, Gladman JR, Husbands SL, Miller P, Dewey ME, Harwood RH. Sooner and healthier: a randomised controlled trial and interview study of an early discharge rehabilitation service for older people. Age and Ageing 2004;33(3):246-52.

    Article  PubMed  Google Scholar 

  24. Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F, et al. A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management. N Engl J Med 2002 03/21;346(12):905-912.

  25. Saltvedt I, Mo OME-, Fayers P, Kaasa S, Sletvold O. Reduced Mortality in Treating Acutely Sick, Frail Older Patients in a Geriatric Evaluation and Management Unit. A Prospective Randomized Trial. J Am Geriatr Soc 2002;50(5):792-798.

    Article  PubMed  Google Scholar 

  26. Kircher TTJ, Wormstall H, Müller PH, Schwärzler F, Buchkremer G, Wild K, et al. A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients. Age and Ageing 2007 January 01;36(1):36-42.

  27. Nikolaus T, Specht-Leible N, Bach M, Oster P, Schlierf G. A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age Ageing 1999 -10-31;28(6):543-550.

  28. Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment. Archives of Physical Medicine and Rehabilitation 2003;84(6):890-7.

    Article  PubMed  Google Scholar 

  29. Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano A,Jr., et al. Interventions Used In Disease Management Programmes For Patients With Chronic Illness: Which Ones Work? Meta-Analysis Of Published Reports. BMJ: British Medical Journal 2002 Oct. 26;325(7370):pp. 925-928.

  30. Ouwens M, Wollersheim H, Hermens R, Hulscher M, Grol R. Integrated care programs for chronically ill patients: a review of systematic reviews. Int J Qual Health Care 2005;17:141-146.

    Article  PubMed  Google Scholar 

  31. Buurman B, Parlevliet J, van Deelen B, de Haan R, de Rooij S. A randomised clinical trial on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: the Transitional Care Bridge. BMC Health Services Research 2010;10(1):296.

    Article  PubMed Central  PubMed  Google Scholar 

  32. J. G. Hoogerduijn. Identification of older hospitalized patients at risk for functional decline. Oisterwijk, The Netherlands: Utrecht University; 2011.

    Google Scholar 

  33. Kempen GI. (Assessment of health status of the elderly. Application of a Dutch version of the MOS scale). Tijdschrift voor Gerontologie en Geriatrie 1992;23(4):132-40.

    CAS  PubMed  Google Scholar 

  34. Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. Journal of Neuropschiatry and Clinical Neurosciences 2000;12(2):233-9.

    Article  CAS  Google Scholar 

  35. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

    Article  CAS  PubMed  Google Scholar 

  36. Rockwood K. Use of goal attainment scaling in measuring clinically important change in the frail elderly. J Clin Epidemiol 1993;46(10):1113.

    Article  CAS  PubMed  Google Scholar 

  37. Rockwood K. Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment. J Clin Epidemiol 2003;56(8):736.

    Article  PubMed  Google Scholar 

  38. Bouwens SF, van Heugten CM, Verhey FR. Review of goal attainment scaling as a useful outcome measure in psychogeriatric patients with cognitive disorders. Dementia and Geriatric Cognitive Disorders 2008;26(6):528-540.

    Article  PubMed  Google Scholar 

  39. Joyce BM, Rockwood KJ, Matekole CC. Use of Goal Attainment Scaling in Brain Injury in a Rehabilitation-Hospital. Am J Phys Med Rehabil 1994 FEB;73(1):10-14.

  40. Bakker TJEM, van der Lee J. Integratieve reactivering en rehabilitatie (IRR) Een revalidatieprogramma voor kwetsbare ouderen, lijdend aan multipele psychiatrische functiestoornissen, en hun mantelzorgers. Tijdschrift voor VerpleeghuisGeneeskunde 2009;34(1):24-28.

    Article  Google Scholar 

  41. Bakker TJEM, Duivenvoorden HJ, van der Lee J, Olde Rikkert MGM, Beekman ATF, Ribbe MW. Integrative Psychotherapeutic Nursing Home Program to Reduce Multiple Psychiatric Symptoms of Cognitively Impaired Patients and Caregiver Burden: Randomized Controlled Trial. American Journal of Geriatric Psychiatry 2011;19(6):507-520.

    Article  PubMed  Google Scholar 

  42. Sheaff R, Boaden R, Sargent P, Pickard S, Gravelle H, Parker S, et al. Impacts of case management for frail elderly people: a qualitative study. J Health Serv Res Policy. 2009;14(2):88-95.

    Article  PubMed  Google Scholar 

  43. Asmus-Szepesi K, de Vreede P, Nieboer A, van Wijngaarden J, Bakker T, Steyerberg E, et al. Evaluation design of a reactivation care program to prevent functional loss in hospitalised elderly: A cohort study including a randomised controlled trial. BMC Geriatrics 2011;11(1):36.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Horner S, Rew L, Torres R. Enhancing intervention fidelity: a means of strengthening study impact. Journal for specialists in pediatric nursing 2006 -01-01;11(2):80-89.

  45. Mowbray CT, Holter MC, Teague GB, Bybee D. Fidelity Criteria: Development, Measurement, and Validation. American Journal of Evaluation 2003 September 01;24(3):315-340.

  46. Perepletchikova F, Kazdin AE. Treatment Integrity and Therapeutic Change: Issues and Research Recommendations. Clinical Psychology: Science and Practice 2005;12(4):365-383.

    Google Scholar 

  47. Santacroce SJ, Maccarelli LM, Grey M. Intervention fidelity. Nurs Res 2004 JAN-FEB;53(1):63-66.

  48. Allen S, Bartlett T, Ventham J, McCubbin C, Williams A. Benefits of an older persons’ assessment and liaison team in acute admissions areas of a general hospital. Pragmatic and Observational Research 2010;1:1-6.

    Article  Google Scholar 

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Dankbetuigingen

De auteurs zijn erkentelijk voor de medewerking van de patiënten en mantelzorgers die het ZPH programma volgen. We danken het Vlietland Ziekenhuis, het Sint Franciscus Gasthuis en het Ruwaard van Putten Ziekenhuis voor de ondersteuning van het programma, evenals de Argos Zorggroep voor het initiatief en verdere uitwerking van de interventie. Ook danken we Judith van de Bosch voor haar deskundige bijdrage aan de subsidieaanvraag en Brian Devine voor het kritisch beoordelen van de intellectuele inhoud. Tenslotte danken we het Geriatrisch Netwerk Rotterdam (GENERO) voor hun waardevolle bijdrage aan de ontwikkeling van het programma.

Het onderzoek is mogelijk gemaakt door een subsidie van ZonMw (nr. 60-61900-98-130) in het kader van het Nationaal Programma Ouderenzorg. Dit heeft als doel het verbeteren van de kwaliteit van zorg voor ouderen door hen integrale zorg te bieden die is afgestemd op hun individuele behoeften.

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Authors and Affiliations

  1. Instituut Beleid & Management Gezondheidszorg, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands

    A. J. B. M. de Vos, J. D. H. van Wijngaarden & A. P. Nieboer

  2. Maatschappelijke GezondheidsZorg, Erasmus MC, Rotterdam, The Netherlands

    K. J. E. Asmus-Szepesi, P. L. de Vreede, E. W. Steyerberg & J. P. Mackenbach

  3. Stichting Wetenschap Balans en Lector Hogeschool Rotterdam, Rotterdam, The Netherlands

    T. J. E. M. Bakker

Authors
  1. A. J. B. M. de Vos
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  2. K. J. E. Asmus-Szepesi
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  3. T. J. E. M. Bakker
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  4. P. L. de Vreede
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  5. J. D. H. van Wijngaarden
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  6. E. W. Steyerberg
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  7. J. P. Mackenbach
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  8. A. P. Nieboer
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Corresponding author

Correspondence to A. J. B. M. de Vos.

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de Vos, A.J.B.M., Asmus-Szepesi, K.J.E., Bakker, T.J.E.M. et al. Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel. Tijdschr Gerontol Geriatr 46, 12–27 (2015). https://doi.org/10.1007/s12439-014-0100-6

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