Approximately 20‐30% of all older people experiences disabilities in performing
(instrumental) activities of daily living. Around 50% of these disabilities develop
progressively, in combination with an underlying chronic disease such as arthritis, diabetes
or chronic obstructive pulmonary disease. The other 50% develops as a consequence of an
acute event, such as hospital admission, stroke, or hip fracture. Acute hospitalization
itself is a hazardous event for elderly people. Older people that are hospitalized have an
increased risk to develop new disabilities compared to those never admitted. Activities of
daily living lost and not recovered by hospital discharge are often difficult to regain.
Approximately a 100,000 Dutch older people annually experience new disabilities after
hospitalization, defined as functional decline. Not all acutely admitted older patients are
at equal risk for functional decline and mortality after hospitalization. Several clinical
factors, in particular, the presence of multiple morbidities and the presence of geriatric
conditions, are related to an increased risk for poor outcomes.
The general aim of this thesis was to investigate strategies for screening and diagnostic
assessment on geriatric conditions to prevent functional decline and other hospital related
complications in acutely hospitalized patients. One of these strategies is the DEFENCE‐care
model; a three‐step systematic approach to prevent functional decline that was developed
as part of this thesis.