Abstract
BackgroundElderly persons admitted to the hospital are at risk for hospital related functional loss. This evaluation aims to compare the effects of different levels of (integrated) health intervention care programs on preventing hospital related functional loss among elderly patients by comparing a new intervention program to two usual care programs.Methods/DesignThis study will include an effect, process and cost evaluation using a mixed methods design of quantitative and qualitative methods. Three hospitals in the Netherlands with different levels of integrated geriatric health care will be evaluated using a quasi-experimental study design. Data collection on outcomes will take place through a prospective cohort study, which will incorporate a nested randomised controlled trial to evaluate the effects of a stay at the centre for prevention and reactivation for patients with complex problems. The study population will consist of elderly persons (65 years or older) at risk for functional loss who are admitted to one of the three hospitals. Data is prospectively collected at time of hospital admission (T0), three months (T1), and twelve months (T2) after hospital admission. Patient and informal caregiver outcomes (e.g. health related quality of life, activities of daily living, burden of care, (re-) admission in hospital or nursing homes, mortality) as well as process measures (e.g. the cooperation and collaboration of multidisciplinary teams, patient and informal caregiver satisfaction with care) will be measured. A qualitative analysis will determine the fidelity of intervention implementation as well as provide further context and explanation for quantitative outcomes. Finally, costs will be determined from a societal viewpoint to allow for cost effectiveness calculations.DiscussionIt is anticipated that higher levels of integrated hospital health care for at risk elderly will result in prevention of loss of functioning and loss of quality of life after hospital discharge as well as in lower burden of care and higher quality of life for informal caregivers. Ultimately, the results of this study may contribute to the implementation of a national integrated health care program to prevent hospital related functional loss among elderly patients.Trial registrationThe Netherlands National Trial Register: NTR2317
Highlights
Persons admitted to the hospital are at risk for hospital related functional loss
The results of this study may contribute to the implementation of a national integrated health care program to prevent hospital related functional loss among elderly patients
Among 70year olds who are admitted in the hospital, 35% show functional loss at time of discharge when compared to the period before hospital admission, and this percentage rises as high as 65% for persons aged 90 years or older [2]
Summary
Persons admitted to the hospital are at risk for hospital related functional loss. Among 70year olds who are admitted in the hospital, 35% show functional loss at time of discharge when compared to the period before hospital admission, and this percentage rises as high as 65% for persons aged 90 years or older [2]. Hospital related functional loss among elderly is often associated with the risk of developing complications due to an illness or its treatment [1]. Functional loss among elderly persons is only partly the result of the patient’s diagnosed illness at admission and treatment thereof [2], implicating that a hospital stay by itself leads to functional loss as well. It is important to prevent or reduce functional loss among elderly at an early stage [9]
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