Geriatrics in primary care

The research within our LUMC departments is conducted within departmental research programmes. The research programme below is embedded within the department of Public Health and Primary Care.

Aim and focus

The overall aim of the research programme ‘geriatrics in primary care’ is to improve medical care for all elderly persons outside the hospital by building up scientific knowledge and evidence. In this hprogramme, primary care is defined as ‘outside the hospital’, thus including medical care for elderly in general practices, nursing homes, homes for the elderly and population-based preventive medicine. There are not only gaps of knowledge on epidemiology of diseases and syndromes, their diagnosis and optimal treatment in old age, but also on aetiology and possibilities for prevention of consequences of diseases. This will not only be studied for separate diseases but especially for combinations of diseases and syndromes, as frequently occurs in old age. In addition to these clue questions, also the organisation of medical care for the elderly will be studied to come to cost-effective treatments and screenings activities in old age.

Position in international context

Our research group is one of the few that studies geriatrics in primary care. We have good international collaboration with Katholieke Universiteit Leuven (prof.dr B. Aertgeerts), Universite catolique de Louvain (prof. J Degryse), RAND/UCLA USA (prof. P. Shekelle) and New Castle University (prof.dr T. Kirkwood).

Content / highlights / achievements

This research programme started in 2005. Main ongoing projects are: PROMODE is a cluster-randomised controlled trial to study the costs and effects of screening and subsequent treatment offer in elderly from age 75 years onwards in general practice (Doelmatigheid ZONMW, 2006-2009) PRIMUS studies the pros and cons of a preventive health service for elderly persons, and aims to present an evidence-based prevention health program for the elderly (Werkplaats publieke gezondheid ZONMW 2006-2010) MASCARPONE studies motivating and demotivating factors for participation to preventive screening for retinopathy in patients with diabetes (Diabetes Fonds Nederland, 2006-2008) CRANBERRY is a randomised controlled trial to study the costs and effects of use of cranberry extract for prevention of clinical urinary tract infections in nursing home patients (doelmatigheid ZONMW 2008-2011) ‘Cardiovascular risk management in old age’ aims to develop evidence based strategies for cardiovascular risk prevention in old age. We started to study which elderly are at risk for cardiovascular diseases after age 85 years and to investigate whether this is generalisable to younger elder. Thereafter we aim to develop optimal treatment strategies for those elderly who are at risk. ‘Aetiology and evidence-based diagnosis of anaemia in old age’ aims to investigate the underlying causes of anaemia in old age. Anaemia is a highly prevalent and incident disease with serious negative consequences on functioning and mortality. Evidence-based diagnosis and therapy is not possible due to lacking knowledge about the aetiology of anaemia in oldest old persons. ‘Rehabilitation in nursing homes’ aims to make a description of the current patients on rehabilitation-wards in nursing homes, to describe the type and amount of care and to assess outcome parameters. In addition, the effect of more intensive self-training programmes with robotics for postoperative and hemiplegic patients at home and in day-care centres should be developed.

Cohesion within LUMC

In this research program there is a strong collaboration within the LUMC with the departments of Gerontology and Geriatrics (Westendorp), Psychiatry (van der Mast), Medical decision making (van den Hout), Medical statistics (Le Cessie), Cardiology (Jukema), Medical informatics (Zwetsloot) and Pulmonary diseases (Rabe). In general, we always assure methodological and content specialist input from other LUMC departments in our research projects. Regional embedding: the Department has 3 research networks. One of nursing homes (Universitair Verpleeghuis Netwerk Zuid Holland, UVN-ZH, 6 long-term care organizations with over thirty nursing homes and homes for the elderly, 6000 patients), one for general practice (Leids Eerstelijns Onderzoeksnetwerk, LEON, 120 Practices, 300.000 patients) and one for public health (Academic Collaborative Center for Public health; 3 regional health services in the region). The department participates in the Geriatric Network of the Regional Committee (providing the chairman). This enables acquisition of relevant research questions and transfer of research findings into the region. In addition, with this variety of networks in the vicinity of the LUMC, in these networks research questions on the cutting edge between care institutions and providers can be studied.