Use of the comprehensive geriatric assessment to improve patient-centred care in complex patient populations

The core of this thesis exists of the Transitional Care Bridge (TCB) and the SYMBOL study (SYstematic Memory testing Beholding Other Languages). The TCB was a randomized controlled trial, to test whether an intervention of a comprehensive geriatric assessment (CGA) plus the TCB program (optimal care during admission and transition to home, combined with intensive home follow up after discharge by a community‐care nurse) improved activities of daily living and decreased mortality 6 months after admission, compared to CGA alone. The patient prioritized all problems that were discovered during the CGA, which was the base for an individualised care and treatment plan. After this the TCB program started. This resulted in a 25% lower six‐month mortality rate among patients in the intervention arm.
We developed a new cognition screening instrument, the Cross Cultural Dementia screening (CCD), which could screen for cognitive impairment in immigrants with different ethnicities and languages in the Netherlands, and which was applicable in elderly with low to no education. In SYMBOL, we used the CCD to assess prevalence of mild cognitive impairment (MCI) and dementia in immigrants with Turkish, Moroccan and Surinamese backgrounds in the Netherlands. in Turkish, Moroccan and Surinamese‐Hindustani participants, MCI was 2-4 times more prevalent, and dementia was 3-4 times more prevalent compared to native Dutch. Presence of cardiovascular diseases (CVD) was associated with a higher chance of cognitive impairment (MCI or dementia) among the Surinamese participants. Among Turkish and Moroccan participants, CVD had less influence.