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Type PhD thesis
Title Screening, geriatric assessment and intervention strategies to prevent
functional decline in hospitalized older patients
Author(s) B.M. Buurman
Faculty AMC-UvA
Year 2011
FULL BIBLIOGRAPHIC DETAILS:
http://hdl.handle.net/11245/1.366259
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Screening, Geriatric Assessment and Intervention
Strategies to Prevent Functional Decline in
Hospitalized Older Patients
Screening, Geriatric Assessment and Intervention Strategies to Prevent Functional Decline
in Hospitalized Older Patients.
PhD thesis, University of Amsterdam, The Netherlands
© Bianca M. Buurman, Haarlem, The Netherlands 2011
All rights reserved. No part of this thesis may be reproduced or transmitted in any form or
by any means without prior permission of the author. A digital version of this thesis can be
found at www.dare.uva.nl
Lay‐out & Cover: J.W. Broek
Printed by: Gildeprint (www.gildeprint.nl)
The printing of this thesis is financially supported by: Nutricia Advanced Medical Nutrition,
Novartis Pharma B.V., Lundbeck B.V.
Screening, Geriatric Assessment and Intervention
Strategies to Prevent Functional Decline in
Hospitalized Older Patients
ACADEMISCH PROEFSCHRIFT
ter verkrijging van de graad van doctor
aan de Universiteit van Amsterdam
op gezag van de Rector Magnificus
prof. dr. D.C. van den Boom
ten overstaan van een door het college voor promoties ingestelde
commissie, in het openbaar te verdedigen in de Aula der Universiteit
op vrijdag 16 september 2011, te 11.00 uur
door
Bianca Maria Van Es
geboren te Rotterdam
Promotiecommissie
Promotores: Prof. dr. M.M. Levi
Prof. dr. R.J. de Haan
Co‐promotor Dr. S.E.J.A. de Rooij
Overige leden: Prof. dr. P.J.M. Bakker
Prof. dr. J. Gussekloo
Prof. dr. M.G.M Olde‐Rikkert
Prof. dr. E. Schadé
Prof. dr. I.N. van Schaik
Faculteit der Geneeskunde
Contents
Chapter 1 General Introduction 7
Chapter 2 Variability in Measuring (I)ADL Functioning and Functional Decline
in Hospitalized Older Medical Patients: a Systematic Review 19
Chapter 3 Risk for Poor Outcomes in Older Patients Discharged from an
Emergency Department: Feasibility of Four Screening Instruments 39
Chapter 4 Prognostication in Acutely Admitted Older Patients by Nurses and
Physicians 55
Chapter 5 The Prediction of Functional Decline in Older Hospitalized Patients 77
Chapter 6 Geriatric Conditions in Acutely Hospitalized Older Patients:
Prevalence and One‐year Survival, Functional Decline and Cognitive
Impairment 95
Chapter 7 Clinical Characteristics and Outcomes of Hospitalized Older Patients
with Distinct Risk Profiles for Functional Decline: a Prospective
Cohort Study 115
Chapter 8 A Randomised Clinical Trial on Comprehensive Geriatric Assessment
and Intensive Home Follow‐up after Hospital Discharge: the
Transitional Care Bridge 135
Chapter 9 General Discussion 155
Chapter 10 Summary 169
Chapter 11 Summary in Dutch (Samenvatting) 175
Publications 181
Curriculum Vitae 187
Acknowledgements (Dankwoord) 189
General Introduction
Chapter 1
Excerpt of the introduction and general
discussion submitted for publication
‘Acute hospitalization and disability’
Chapter 1
Chronic diseases and the onset of disability
The prevalence of chronic diseases gradually increases with age and has shown an overall
growth in the past decades 1. This is partly due to early recognition of chronic diseases by
screening programs and to aging of the population. Compared to patients younger than 65
years, older patients more frequently have a combination of chronic diseases. This co‐
occurrence of two or more diseases is defined as multimorbidity 2 and its prevalence in
community‐dwelling patients ranges from 35‐65% in patients aged 60‐69 years, to 80‐99%
in patients aged 80 years and older 3;4.
Chronic diseases are often accompanied by disability. In order to structure and describe
disease outcomes in a systematic and hierarchical manner the World health Organization
developed the International Classification of Functioning, Disability and Health (ICF, Figure
1) 5 6. According to this scheme the disablement process starts with a certain disease or
health condition in the body. The specific disease can lead to impairments in body
functions and structures, such as retinopathy (impairment) in diabetes patients
(underlying disease). Impairments can be clinically silent or can be detectable and may
lead to functional limitations (disabilities) which in turn may result in societal
disadvantages (restrictions in participation or handicap). Important components of the ICF
are the environmental and personal factors of the patients that can speed up or slow
down the disablement process.
Environmental factors concern the presence of primary care givers, social support,
technological devices and financial resources which can compensate a persons’ individual
inability to perform certain activities. Personal factors such as personality traits, coping
styles, educational level, and lifestyle are far more difficult to influence.
8
Description:Contents. Chapter 1. General Introduction. 7. Chapter 2. Variability in Measuring (I)ADL Functioning and Functional Decline in Hospitalized Older Medical Patients: a Systematic Review. 19. Chapter 3. Risk for Poor Outcomes in Older Patients Discharged from an. Emergency Department: Feasibility of
