A proactive approach to complex problems in older people

Abstract

The results of this thesis shed new light on two important issues for evidence-based general practice care for older people: 1) the feasibility of the (proactive) identification of older people with complex problems and 2) the effectiveness of proactive integrated care for older people with complex problems in general practice. We investigated five measures to identify older people with complex problems, i.e. a profile of laboratory measurements, handgrip and quadriceps muscle strength, Fried's frailty phenotype criteria, the clinical intuition of the GP, and the ISCOPE screening questionnaire. These measures each identified a complex group of older people, but none of these measures can be recommended as the most feasible for general practice. In the ISCOPE study, a proactive integrated care plan had no direct effect on functional decline and quality of life of older people with complex problems. This lack of effect might be attributed to the study design or to the intervention itself. Although this effect could not be demonstrated, in our opinion integrated care still remains the best type of care available for this age-group. We believe this is confirmed by the level of satisfaction of both older people and GPs who were included in the intervention group.