Nurse-led multifactorial care in community-dwelling older people: Outcomes on daily functioning, experiences and costs

The overall aim of this thesis was to improve primary care for community-dwelling older people in the Netherlands. First, by studying the effectiveness of multifactorial care on health and daily functioning of community-dwelling older people, second by exploring the value of the multifactorial care by investigating experiences of older people with this nurse-led multifactorial care, and third by assessing per capita healthcare costs of older people. We evaluated the effects of nurse-led multifactorial care in a cluster randomized controlled trial. 11 practices (n=1,209 participants) were randomized to the intervention group, 13 practices (n=1,074 participants) were randomized to the control group. We found no evidence that a one-year individualized multifactorial intervention program with nurse-led care coordination resulted in prevention or postponement of new disabilities in community-dwelling older people at increased risk of functional decline. One explanation might be that by conducting a comprehensive geriatric assessment many geriatric conditions were detected, yet resulted in low recognition rates of these geriatric conditions by older people themselves. Nevertheless, older people appreciated nurse-led multifactorial care, especially because of the feeling of being looked after. Hospitalization costs were the most important contributor to the overall healthcare costs of older people. Especially older people who encounter functional decline had the highest healthcare costs. Further studies should focus on shared decision making and collaboration with older people to improve overall quality of care.