PhD Thesis: Facing Frailty – Exploring the effectiveness of integrated care for frail older people

Friday 14 December 2018, Willemijn Looman will defend her thesis. 
Below you can read a summary of the thesis. Interested in the full thesis? Click here to go to the electronic version.


Integrated care is advocated as a promising solution to overcomebarriers in the fragmented health care system for populations with complexneeds such as frail older people. However, it remains unclear whether integratedcare can meet the high and diverse expectations. The aim of the thesis ofWillemijn Looman was therefore to explore the (cost-)effectiveness ofpreventive, integrated care for community-dwelling frail older people.

Part A of her thesis focuses on the Walcheren Integrated Care Model (WICM), a comprehensive intervention combining evidence-based elements.  The quasi-experimental evaluation study showed that the WICM had a positive effect on the dimension ‘love and friendship’ and, a moderately positive effect on general quality of life. Nevertheless, no effects were found on health outcomes such as mental health and social functioning and functional abilities and the WICM was not cost-effective.

Part B of this thesis critically reflects the concepts and methodologies used to explore the (cost-) effectiveness of integrated care for frail older. A systematic review revealed that the majority of the outcomes showed no significant effects. A further exploration of the target population of frail older people showed that six frailty profiles could be distinguished from a population of 43,000 older people ranging from relatively healthy to multi-frail. Thé frail older person does not exist. The effectiveness of integrated care was determined for each of the six frailty profiles and showed that no effects were substantiated in terms functional limitations, mental health, social functioning, health-related quality of life and general quality of life.

Integrated care could be more properly aligned to the target populationof frail older people. Integrated care interventions in primary care settingsremain characterized by medical dominance, whereas, a more holistic andperson-centered approach that also includes services from the social sector mightbe required. Moreover, prevention might be integrated more carefully within theintegrated care interventions. Effective integrated care also requires researchthat is integrated, continuous, and person-centred to cover the complexities ofdaily practice. Bridges should be built between research, practice and policyand also researchers should work together more closely.

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