Evaluation of the Prevention and Reactivation Care Program (PreCaP) for the hospitalized elderly: a prospective nonrandomized controlled trial

Abstract

Background

The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly.

Methods

The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP), while two other hospitals providing usual care served as control settings. Within the PReCaP hospital we compared patients pre-implementation with patients post-implementation of the PReCaP (“within-hospital analysis”), while our nonrandomized controlled trial compared patients of the PReCaP hospital post-implementation with patients from the two control hospitals providing usual care (“between-hospital analysis”). Hospitalized patients 65 years or older and at risk of functional decline were interviewed at baseline and at 3 and 12 months using validated questionnaires to score functioning, depression, and health-related quality of life (HRQoL). We estimated costs per unit of care from hospital information systems and national data sources. We used adjusted general linear mixed models to analyze functioning and HRQoL.

Results

Between-hospital analysis showed no difference in activities of daily living (ADL) or instrumental activities of daily living (IADL) between PReCaP patients and control groups. PReCaP patients did have slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2–0.6]), lower depression (Geriatric Depression Scale 15; −0.9 [95% −1.1 to −0.6]) and higher perceived health (Short-Form 20; 5.6 [95% CI 2.8–8.4]) than control patients. Analyses within the PReCaP hospital comparing patients pre-and post-implementation of the PReCaP showed no improvement over time in functioning, depression, and HRQoL. One-year health care costs were higher for PReCaP patients, both for the within-hospital analysis (+€7,000) and the between-hospital analysis (+€2,500).

Conclusion

We did not find any effect of the PReCaP on ADL and IADL. The PReCaP may possibly provide some benefits to hospitalized patients at risk of functional decline with respect to cognitive functioning, depression, and perceived health. Further evaluations of integrated intervention programs to limit functional decline are therefore required.

Keywords:

• functional decline
• geriatric rehabilitation
• health-related quality of life
• activities of daily living

Acknowledgments

This work was supported by a grant (number 60-61900-98-130) from the Netherlands Organization for Health Research and Development (ZonMw) as part of the National Care for the Elderly Program. The sponsor (ZonMw) was not involved in any aspect of our research or in preparing the manuscript. Other contributors to this study were Annemarie de Vos and Jeroen van Wijngaarden, who provided us with valuable information on the process evaluation. Also we would like to thank Rianne van Eijsden and all data collectors/interviewers for their valuable contributions made to data collection and Gerard Borsboom for his statistical support.

Author contributions

KJA performed statistical analyses, and drafted and edited the manuscript. LEF performed statistical analyses and editing of the manuscript. MAK was involved in study design and analysis of costs as well as editing the manuscript. APN and TJB were involved in the overall study design and editing of the manuscript. JPM and ES were involved in the overall study design, planning of statistical analyses, and editing of the manuscript. All authors contributed to writing and critically reviewing the manuscript and approved the final version for publication.

Disclosure

The authors declare no conflicts of interest in this work.