Author: Kim de Nooijer
Date: 08-07-2022
Supervisors:
Prof. dr. Lieve Van den Block (Supervisor Vrije Universiteit Brussel)
Prof. dr. Lara Pivodic (Co-supervisor Vrije Universiteit Brussel),
Summary of the dissertation
People live increasingly longer, but they often do not spend their last phase of life in
good health. Many older persons experience long periods of illness, multimorbidity,
or frailty prior to dying, along with symptoms and concerns across physical,
psychosocial, and spiritual domains. Palliative care is indicated for older people
with serious chronic conditions, as it aims to address the multidimensional problems
associated with life-threatening illness by means of early identification, assessment,
and treatment. However, there is limited evidence on which palliative care service
models are best in addressing this population’s complex care needs.
First, this dissertation gives insight into current palliative care services for older
people as well as their palliative care needs. Secondly, it describes the development
of a theory-based, timely and short-term specialised palliative home care service
intervention (called Frailty+ intervention) for older people with frailty and complex
care needs and their family. Finally, this dissertation describes the pilot randomised
controlled trial conducted to evaluate the feasibility, implementation, and preliminary
effectiveness of the Frailty+ intervention. The results of this work show that the
Frailty+ intervention has the potential to improve patient and family outcomes.
However, its implementation in clinical practice – and particularly the timely start
of palliative care – is very challenging as it requires difficult changes in current
practices of palliative care services. This work provides recommendations for further
adaptation and improvement of the Frailty+ intervention and its theoretical model
and more broadly, for the role of specialised palliative care services in the care for
older people with frailty
