Hospital admission is considered a health risk for older patients. Thirty-five percent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases to 50% for 85-year old patients . Functional decline in elderly patients is not necessarily related to the medical condition of the patient. Several other factors play a major role in the occurrence of the functional decline, including iatrogenic effects of the treatment and the effects of hospitalization, such as immobilization, isolation, and inaccessibility to fluids . Furthermore, age, lower functional status before hospital admission, impaired cognitive status, depression and prolonged length of hospital stay are significant predictors of hospital related functional decline in elderly patients [3–5]. Functional decline can be defined as a new loss of independence in self-care activities or as deterioration in self-care skills, measured on an activities of daily living (ADL) scale (e.g. bathing, dressing, transferring from bed to chair, using the toilet) and/or on an instrumental activities of daily living (IADL) scale (e.g. shopping, housekeeping, preparing meals) [6, 7]. Not only activities of daily living can be compromised. Functional decline may also result in physical and psychosocial problems, such as dehydration, malnutrition, falls, depression, and delirium [1, 2, 8].
Our earlier research demonstrated that 47% of the group of elderly patients (> 60 years) can be considered to be at risk for functional decline during hospitalization, due to the presence of four or more risk factors, including home care, history of falls, polypharmacy, weight loss (more than one kilogram in the past month), and psychiatric symptoms (anxiety, depression) . It is anticipated that a considerable part of these elderly patients at risk require intensive reactivation during hospital admission and after discharge in a hospital replacement care facility, often due to the patient's failure to recognize the potential problems or the lack of informal caregivers.
The literature demonstrates several approaches aimed at preventing functional decline in hospitalized elderly with mixed results. The Comprehensive Geriatric Assessment (CGA) comprising of a screening for risks for adverse outcomes, a diagnostic assessment on the presence of geriatric conditions and multidisciplinary tailored interventions, has most often been studied. Early screening of the elderly by means of the CGA has demonstrated a reduction in cognitive and functional decline in patients at risk [9, 10], and to retaining quality of life and independence in activities of daily living . The implementation of the CGA resulted in lower mortality rates in the elderly after six months, but not after 12 months follow-up . Multidisciplinary interventions, including physical training are associated with a reduction in functional decline [13, 14], reduced length of hospital stay at the same costs compared to 'regular care' [13–16], lower (re)admissions to hospital and nursing homes [17–19], reductions in fall incidence [15, 20], higher perceived health and life satisfaction among patients [18, 21, 22]. Evidence shows that these effects are present between six and twelve months after the start of the intervention with the largest effect at three months . Various studies have emphasized the importance of utilizing specialized geriatric units, often in combination with multidisciplinary follow up-treatment, including case management after hospital discharge with rehabilitation service [19, 23–26].
Hospital related functional decline in elderly patients is an underestimated problem. In The Netherlands medical treatment and nursing care largely focuses on the diagnosed illness, thereby neglecting reactivation care that may prevent functional decline in the elderly patient. The Prevention and Reactivation Care Program (PReCaP) [Zorgprogramma voor Preventie en Herstel (ZPH)] was developed to address this issue by utilizing a multidisciplinary, integrated and goal-oriented approach focused at the early screening of risk factors for functional decline and the provision of a patient-oriented reactivation program. Given the large body of evidence, it is expected that this approach will lead to improved functional status and better quality of life for the elderly for twelve months after hospitalization, reductions in fall incidence, reduced length of hospital stay, lower (re)admissions to hospital and nursing homes, improved mental well-being of informal caregivers, and lower mortality [13, 15, 18, 20–23, 25, 27–30].
There is a paucity of detailed descriptions of geriatric interventions in the international literature. This paper addresses this issue by presenting an outline of the Prevention and Reactivation Care Program (PReCaP) including community involvement; the roles and responsibilities of core staff; the setting and administrative structure; the care process - including identification and screening procedure, key interventions, use of the standardized Goal Attainment Scaling (GAS) method, follow-up treatment at the Prevention and Reactivation Centre, multidisciplinary approach, case management, provision of support to informal caregivers, quality assurance measures -; and the expected outcomes and benefits.