Older persons living with medical conditions, disabilities, frailty, and/or mild to moderate cognitive decline Other
Conditions
Interventions
In the intervention condition, the ValueCare approach will be applied. In the control condition ‘usual care’ is applied. Each pilot site will design an integrated care pathway based on the ValueCare m
Sponsors
Erasmus MC
Eligibility
Sex/Gender
All
Age
65 Years to 100 Years
Inclusion criteria
Inclusion criteria: 1. Older persons: 1.1. Aged =65 years 1.2. Have a confirmed diagnosis of the targeted chronic condition at the time of enrolment 1.3. Community-dwelling (not living in long-term care facilities) or are temporarily in a hospital or institution and are expected to be referred to outpatient rehabilitation services 1.4. Able to give informed consent 2. Informal and formal caregivers: 2.1. Informal caregivers (e.g., relatives, friends) of participating older persons will be approached to participate in the study 2.2. Health and social care practitioners who work with older persons having the targeted condition in each pilot site will be approached to participate in the study
Exclusion criteria
Exclusion criteria: Unable to comprehend the information provided in the local language or cannot cognitively evaluate the risks and benefits of participation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Health-related quality of life (HR-QoL) score measured using the PROMIS Scale v1.2 – Global Health (PROMIS-10) at baseline, 12, and 18 months | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Loneliness measured using the UCLA 3-Item Loneliness Scale (Hughes et al., 2004) at baseline, 12, and 18 months 2. Alcohol consumption measured using one item of the International Consortium for Health Outcomes Measurement (ICHOM, 2016) at baseline, 12, and 18 months 3. Smoking status measured using one item of the ICHOM at baseline, 12, and 18 months 4. Nutrition and undernutrition measured using the SNAQ65+ (Wijnhoven et al., 2012) at baseline, 12, and 18 months 5. Physical activity measured using one item of the SHARE-Frailty instrument (Romero-Ortuno, 2011) and one item of the Internal Physical Activity Questionnaire (IPAQ) on sitting time (Lee et al., 2011) at baseline, 12, and 18 months 6. Frailty measured using the 15-item Tilburg Frailty Indicator (Gobbens, 2010) at baseline, 12, and 18 months 7. Falls-related quality of life measured using the reported number of falls in the previous year and fear of falling on the Visual Analogue Scale for Fear of Falling (Chang & Ganz, 2007) at baseline, 12, and 18 months 8. Medication intake and use measured using the Medication Risk Questionnaire (MRQ-10) (Barenholtz Levy, 2003) at baseline, 12, and 18 months 9. Activities of daily living measured using the modified 10-item Barthel Index (Collin et al., 1988) at baseline, 12, and 18 months 10. Co-morbidities measured using one item of the ICHOM at baseline, 12, and 18 months 11. Health and social care utilization measured using the modified SMRC Health Care Utilization questionnaire (Lorig et al. 2001) at baseline, 12, and 18 months 12. Time spent on providing informal care measured using the iMTA Valuation of Informal Care Questionnaire (iVICQ) (Hoefman et al., 2013) at baseline, 12, and 18 months 13. Carer burden measured using the 4-item Zarit Burden Interview (ICHOM, 2016; Bedard et al., 2001) at baseline, 12, and 18 months 14. Control over daily life measured using the Adult Social Care Outcomes Toolkit (Netten et al., 2012) at baseline, 12, and 18 months 15. Wo | — |
Countries
Croatia, Greece, Ireland, Italy, Netherlands, Portugal, Spain
Contacts
Public ContactHein Raat
Outcome results
None listed