Franka C Bakker1, Anke Persoon2, Sebastian J H Bredie3, Jolanda van Haren-Willems4, Vincent J Leferink5, Luc Noyez6, Yvonne Schoon7, Marcel G M Olde Rikkert7. 1. Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Franka.Bakker@Radboudumc.nl. 2. Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands. 3. Division of General Internal Medicine, Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 4. Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 6. Department of Cardio-Thoracic Surgery, -Heart Center, Radboud University Medical Center, Nijmegen, The Netherlands. 7. Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
BACKGROUND: The objective of this study was to evaluate implementation of an innovative intervention designed to prevent complications and stimulate early rehabilitation among frail elderly inpatients. METHODS: The program was implemented in April 2011. A mixed-methods process evaluation and before-after study were performed. Primary effect outcomes included incidence of hospital-acquired delirium, cognitive decline, and decline in activities of daily living (ADL) during hospital stay. Secondary endpoints included ADL performance 3 months postdischarge, readmission, and caregiver burden. RESULTS: One hundred ninety-one preintervention and 195 postintervention patients aged 70 years or older were included. Overall, no significant differences in primary endpoints were found. Mean ADL between discharge and follow-up improved (3.2 vs 5.7, P = .058). Caregivers rated burden of care lower at 3 months postdischarge (.5 vs -.6, P = .049). CONCLUSIONS: The CareWell in Hospital program was implemented satisfactorily. Although the low baseline delirium incidence (11%), higher comorbidity, and an increasing learning curve during a restricted implementation period potentially influenced the overall effects, this integrated care program may have beneficial effects on outcomes among frail elderly surgical patients.
BACKGROUND: The objective of this study was to evaluate implementation of an innovative intervention designed to prevent complications and stimulate early rehabilitation among frail elderly inpatients. METHODS: The program was implemented in April 2011. A mixed-methods process evaluation and before-after study were performed. Primary effect outcomes included incidence of hospital-acquired delirium, cognitive decline, and decline in activities of daily living (ADL) during hospital stay. Secondary endpoints included ADL performance 3 months postdischarge, readmission, and caregiver burden. RESULTS: One hundred ninety-one preintervention and 195 postintervention patients aged 70 years or older were included. Overall, no significant differences in primary endpoints were found. Mean ADL between discharge and follow-up improved (3.2 vs 5.7, P = .058). Caregivers rated burden of care lower at 3 months postdischarge (.5 vs -.6, P = .049). CONCLUSIONS: The CareWell in Hospital program was implemented satisfactorily. Although the low baseline delirium incidence (11%), higher comorbidity, and an increasing learning curve during a restricted implementation period potentially influenced the overall effects, this integrated care program may have beneficial effects on outcomes among frail elderly surgical patients.
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