Abstract
BackgroundDue to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this ultimately threatens their ability to function independently. Many interventions for frail older people attempt to prevent or delay functional decline, but they show contradicting results. Recent studies emphasise the importance of embedding these interventions into existing primary care systems and tailoring care to older people’s needs and wishes. This article presents the design of an evaluation study, aiming to investigate the effects and feasibility of the early detection of health problems among community-dwelling older people and their subsequent referral to appropriate care and/or well-being facilities by general practices.Methods/DesignA longitudinal, quasi-experimental study is designed comparing 13 intervention practices with 11 control practices. General practices select eligible community-dwelling older people (≥ 75 years). Practice nurses from intervention practices (1) visit older people at home for a comprehensive assessment of their health and well-being; (2) discuss results with the GP; (3) formulate – if required – a care and treatment plan together with the patient; (4) refer patient to care and/or well-being facilities; and (5) monitor and coordinate care and follow-up. Control practices provide usual care and match the intervention practices on the presence of different primary care professionals within the practice. Primary outcome measures are health-related quality of life and disability. Additionally, attitude towards ageing, care satisfaction, health care utilisation, nursing home admission and mortality are measured. Some outcomes are assessed by means of a postal questionnaire (at baseline and after 6, 12, and 18 months follow-up), others through continuous registration over the 18-month period. A profound process evaluation will provide insight into barriers and facilitators for implementing the intervention protocol within general practices from both the patient and caregiver perspective.DiscussionThe proposed approach requires redesigning care delivery within general practices for accomplishing appropriate care for older people. A quasi-experimental design is chosen to closely resemble a real-life situation, which is desirable for future implementation after this innovation proves to be successful. Results of the effect and process evaluation will become available in 2013.Trial registrationThe Netherlands National Trial Register NTR2737
Highlights
Due to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this threatens their ability to function independently
Older people within intervention practices are visited at home by the practice nurse for a multidimensional assessment followed by individualised care, the so-called [G]OLD-protocol: ‘Getting OLD the healthy way’
Proportion of intended target Continuous registration population that participates by general practices and in and completes the researchers intervention: (1) registration number and Individual interviews with reasons for non-response and PNs and General Practitioner (GP) drop-out; (2) opinion PNs and GPs about reach
Summary
Due to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this threatens their ability to function independently. Many interventions for frail older people attempt to prevent or delay functional decline, but they show contradicting results. Ageing of the population poses challenges to health care systems as the number of frail older people who suffer from complex and/or multiple (chronic) health complaints increases [1,2]. A failure to detect health complaints among older people in time may cause unnecessary neediness and may threaten their ability to function independently. Discrepancy in the results is caused, among others, by differences in the selection of the target population, intensity and duration of the intervention (i.e., number of follow-up visits), or domains included in the multidimensional assessment of older people’s health status [12]. Most studies to date employ a randomised design for establishing the success of preventive home visits, thereby hindering close resemblance to a real-life situation and restricting the external validity of findings
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