A cohort study of the effects of multidisciplinary in-patient primary care in older adults

Key summary points

AbstractSection Aim

To evaluate to the effects of a multifactorial, multidisciplinary in-patient municipality intervention on functioning, need-of-care, and quality of life in functionally declining older adults.

AbstractSection Findings

Following the intervention, patients had increased quality of life, which remained at the post-intervention level even after 6 months. Further, participants had lower need-of-care and increased performance in physical function tests.

AbstractSection Message

A well-structured multifactorial and multidisciplinary in-patient intervention may lead to long-term clinically relevant improvements in functionally declining older adults.



To evaluate short and long-term effects of a multifactorial and multidisciplinary in-patient municipality intervention including training of activities of daily living, cardiovascular exercise, resistance training and social activities on quality-of-life, need-of-care, and physical function in older adults at risk of further functional decline.


A cohort study including data collected rigorously during 3.5 years at an in-patient municipality rehabilitation center in Aalborg, Denmark. Patients received a multifactorial and multidisciplinary intervention. Outcomes were quality-of-life (EQ5D), weekly need-of-care hours, and test of physical functioning (sit-to-stand, 6-min walking test, tandem balance).


Data was collected from 532 patients (63.3% women). The median [5; 95 percentiles] age was 79 [55; 92] years with a length-of-stay of 21 [8; 55] days. The mean (95% CI) EQ5D index score showed a clinically relevant improvement from admission 0.46 (0.44; 0.48) to discharge 0.69 (0.67; 0.71) and there was no decline 6-month postdischarge 0.67 (0.64; 0.70). The weekly need-of-care decreased significantly by 7.2 (6.6, 7.9) h from a mean of 9.8 h before admission to 2.6 h 6-month postdischarge. Sit-to-stand improved from 6.3 (6.0; 6.7) to 9.3 (8.9; 9.6) repetitions, 6-min walking test from 147 (138; 156) to 217 (207; 227) m, and tandem balance from 20.7 (19.8; 21.6) to 25.2 (24.8; 26.2) s.


Our results were remarkable and highlight that a well-structured multifactorial and interdisciplinary intervention with a clear aim and inclusion criteria related to functional decline may lead to long-term clinically relevant improvements in functionally declining older adults. Future studies should, however, explore similar interventions in comparable populations preferably in randomized controlled designs.

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Data availability

Upon reasonable request data from the current study can be made available.


  1. 1.

    Mudge AM, O’Rourke P, Denaro CP (2010) Timing and risk factors for functional changes associated with medical hospitalization in older patients. J Gerontol Ser A Biol Sci Med Sci 65A:866–872. https://doi.org/10.1093/gerona/glq069

    Article  Google Scholar 

  2. 2.

    Tanderup A, Lassen AT, Rosholm JU, Ryg J (2018) Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study. BMJ Open. https://doi.org/10.1136/bmjopen-2018-023803

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Matzen LE, Jepsen DB, Ryg J, Masud T (2012) Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit. BMC Geriatr. https://doi.org/10.1186/1471-2318-12-32

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    De Buyser SL, Petrovic M, Taes YE, Toye KRC, Kaufman JM, Goemaere S (2013) Physical function measurements predict mortality in ambulatory older men. Eur J Clin Investig 43:379–386. https://doi.org/10.1111/eci.12056

    Article  Google Scholar 

  5. 5.

    Fried TR, Tinetti ME, Iannone L, O’Leary JR, Towle V, Van Ness PH (2011) Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions. Arch Intern Med 171:1854–1856. https://doi.org/10.1001/archinternmed.2011.424

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Ruikes FGH, Zuidema SU, Akkermans RP, Assendelft WJJ, Schers HJ, Koopmans RTCM (2016) Multicomponent program to reduce functional decline in frail elderly people: a cluster controlled trial. J Am Board Fam Med 29:209–217. https://doi.org/10.3122/jabfm.2016.02.150214

    Article  PubMed  Google Scholar 

  7. 7.

    Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A (2002) A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 347:1068–1074. https://doi.org/10.1056/NEJMoa020423

    Article  PubMed  Google Scholar 

  8. 8.

    Moeldrupnielsen L (2018) effectiveness of the “elderly Activity Performance Intervention” on elderly patients’ discharge from a short-stay unit at the emergency department: a quasi-experimental trial. Clin Interv Aging 13:737–747. https://doi.org/10.2147/CIA.S162623

    Article  Google Scholar 

  9. 9.

    Travers J, Romero-Ortuno R, Bailey J, Cooney M-T (2019) Delaying and reversing frailty: a systematic review of primary care interventions. Br J Gen Pract 69:e61–e69. https://doi.org/10.3399/bjgp18X700241

    Article  PubMed  Google Scholar 

  10. 10.

    Verweij L, van de Korput E, Daams JG, ter Riet G, Peters RJG, Engelbert RHH et al (2018) Effects of post-acute multidisciplinary rehabilitation including exercise in out-of-hospital settings in the aged: systematic review and meta-analysis. Arch Phys Med Rehabil. https://doi.org/10.1016/j.apmr.2018.05.010

    Article  PubMed  Google Scholar 

  11. 11.

    Marzetti E, Calvani R, Tosato M, Cesari M, Di Bari M, Cherubini A et al (2017) Physical activity and exercise as countermeasures to physical frailty and sarcopenia. Aging Clin Exp Res 29:35–42. https://doi.org/10.1007/s40520-016-0705-4

    Article  PubMed  Google Scholar 

  12. 12.

    Ad B, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J et al (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet. https://doi.org/10.1016/S0140-6736(08)60342-6

    Article  Google Scholar 

  13. 13.

    Eklund K, Wilhelmson K (2009) Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials. Health Soc Care Community. https://doi.org/10.1111/j.1365-2524.2009.00844.x

    Article  PubMed  Google Scholar 

  14. 14.

    Low LL-F, Yap M, Brodaty H (2011) A systematic review of different models of home and community care services for older persons. BMC Health Serv Res. https://doi.org/10.1186/1472-6963-11-93

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Sadler E, Potterton V, Anderson R, Khadjesari Z, Sheehan K, Butt F et al (2019) Service user, carer and provider perspectives on integrated care for older people with frailty, and factors perceived to facilitate and hinder implementation: a systematic review and narrative synthesis. PLoS One 14:e0216488. https://doi.org/10.1371/journal.pone.0216488

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Hoogendijk EO (2016) How effective is integrated care for community-dwelling frail older people? The case of the Netherlands. Age Ageing. https://doi.org/10.1093/ageing/afw081

    Article  PubMed  Google Scholar 

  17. 17.

    Liu CJ, Latham N (2011) Can progressive resistance strength training reduce physical disability in older adults? A meta-analysis study. Disabil Rehabil. https://doi.org/10.3109/09638288.2010.487145

    Article  PubMed  Google Scholar 

  18. 18.

    Bray NW, Smart RR, Jakobi JM, Jones GR (2016) Exercise prescription to reverse frailty. Appl Physiol Nutr Metab. https://doi.org/10.1139/apnm-2016-0226

    Article  PubMed  Google Scholar 

  19. 19.

    Hart PD, Buck DJ (2019) The effect of resistance training on health-related quality of life in older adults: systematic review and meta-analysis. Heal Promot Perspect 9:1–12. https://doi.org/10.15171/hpp.2019.01

    Article  Google Scholar 

  20. 20.

    Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A (1997) Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Rheumatology. https://doi.org/10.1093/rheumatology/36.5.551

    Article  Google Scholar 

  21. 21.

    Juel K, Sorensen J, Bronnum-Hansen H (2008) Supplement: Risk factors and public health in Denmark. Scand J Public Health. https://doi.org/10.1177/1403494800801101

    Article  PubMed  Google Scholar 

  22. 22.

    Steffen TM, Hacker TA, Mollinger L (2002) Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. https://doi.org/10.1093/ptj/82.2.128

    Article  PubMed  Google Scholar 

  23. 23.

    Rikli RE, Jones CJ (2013) Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist. https://doi.org/10.1093/geront/gns071

    Article  PubMed  Google Scholar 

  24. 24.

    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. https://doi.org/10.1093/geronj/49.2.M85

    Article  PubMed  Google Scholar 

  25. 25.

    Zou H, Zhang J, Chen X, Wang Y, Lin W, Lin J et al (2017) Reference equations for the six-minute walk distance in the healthy Chinese Han Population, aged 18–30 years. BMC Pulm Med 17:1–10. https://doi.org/10.1186/s12890-017-0461-z

    Article  Google Scholar 

  26. 26.

    Sørensen J, Gudex C, Davidsen M, Brønnum-Hansen H, Pedersen KM (2009) Danish EQ-5D population norms. Scand J Public Health. https://doi.org/10.1177/1403494809105286

    Article  PubMed  Google Scholar 

  27. 27.

    Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A et al (2018) Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults. JBI Database Syst Rev Implement Rep. https://doi.org/10.11124/JBISRIR-2017-003382

    Article  Google Scholar 

  28. 28.

    Walters SJ, Brazier JE (2005) Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. https://doi.org/10.1007/s11136-004-7713-0

    Article  PubMed  Google Scholar 

  29. 29.

    De Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millán-Calenti JC (2015) Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials physical functioning, physical health and activity. BMC Geriatr. https://doi.org/10.1186/s12877-015-0155-4

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Lozano-Montoya I, Correa-Pérez A, Abraha I, Soiza RL, Cherubini A, O’Mahony D et al (2017) Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview—the SENATOR project ONTOP series. Clin Interv Aging. https://doi.org/10.2147/CIA.S132496

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Dedeyne L, Deschodt M, Verschueren S, Tournoy J, Gielen E (2017) Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic review. Clin Interv Aging 12:873–896. https://doi.org/10.2147/CIA.S130794

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Silva RBB, Aldoradin-Cabeza H, Eslick GDD, Phu S, Duque G (2017) The effect of physical exercise on frail older persons: a systematic review. J Frailty Aging. https://doi.org/10.14283/jfa.2017.7

    Article  PubMed  Google Scholar 

  33. 33.

    Lopez P, Pinto RS, Radaelli R, Rech A, Grazioli R, Izquierdo M et al (2018) Benefits of resistance training in physically frail elderly: a systematic review. Aging Clin Exp Res. https://doi.org/10.1007/s40520-017-0863-z

    Article  PubMed  Google Scholar 

  34. 34.

    Brusco NK, Taylor NF, Watts JJ, Shields N (2014) Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings. Arch Phys Med Rehabil 95(94–116):e4. https://doi.org/10.1016/j.apmr.2013.03.017

    Article  Google Scholar 

  35. 35.

    Crapo RO, Casaburi R, Coates AL, Enright PL, MacIntyre NR, McKay RT et al (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. https://doi.org/10.1164/ajrccm.166.1.at1102

    Article  PubMed  Google Scholar 

  36. 36.

    Bohannon RW, Crouch R (2017) Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract 23:377–381. https://doi.org/10.1111/jep.12629

    Article  PubMed  Google Scholar 

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Corresponding author

Correspondence to Johannes Riis.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflicts of interest.

Ethics approval

This cohort study was assessed by the Danish Regional Ethics Committee who stated that no approval was required (mail correspondence on April 28, 2018).

Informed consent

In Denmark, research consisting of retrospective analysis of data stored in registries of routine care does not require informed consent and as a result, participants were not aware they were being studied. All data were pseudo anonymized following the recommended procedures by the Danish Data Protection Agency.

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Jorgensen, M.G., Rodrigo-Domingo, M., Andersen, S. et al. A cohort study of the effects of multidisciplinary in-patient primary care in older adults. Eur Geriatr Med 11, 677–684 (2020). https://doi.org/10.1007/s41999-020-00321-2

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  • Need-of-care
  • Quality of life
  • Physical functioning
  • Frailty
  • Multidisciplinary rehabilitation intervention
  • In-patient care