Table 1.

Overview of initiatives on early detection and intervention for older people in the Netherlands

Category (based on setting)	Target population	Goal	Initiator	Health/social care professionals involved	Scope	Follow-up	Screening methods	Scale
Group 1: initiatives aiming to detect older people at risk of deterioration in order to provide preventive interventions a
1. Initiatives by Elderly Health Centres [63–66]	Varies per initiative: target populations based on for example age, SES, health insurer, location of health care use	To prevent or early detect physical and psychological problems in (frail) older people	Varies per initiative: Home care organisation, municipal mental health care organisation, GP, nurse practitioner, community nurse	Varies per initiative: Community nurse, Municipal Health Services, (occupational) physician, community psychiatric nurse	Physical, psychological and social functioning	Provision of information and advice on lifestyle, preservation of independence and control. Referral to other professionals if necessary	Varies per initiative: For example: an instrument covering 3 domains: 1. Screening for frailty (Groningen Frailty Indicator); 2. Screening for health problems (Intermed) 3. Screening for wellbeing (Groningen Wellbeing Indicator)	Various locations were identified across the Netherlands. Per elderly health centre, a varying group of people was exposed to the initiative (e.g. a whole community; only people from certain GP practices; people affiliated with a specific health insurer)
2. Informative home visit by volunteers [67–69]	All people in a municipality who are 75 years and older	To bring community services to the attention of older people and to detect unidentified problems	Volunteer from welfare/volunteer organization	Welfare/volunteer organization, professional elderly advisor	Health, wellbeing, living circumstances, social participation	Provision of advice on services that can facilitate self-reliance and participation	Screening instruments are often not used. In some municipalities, a questionnaire or list with topics regarding activities, social relations, mobility, finances, nutrition is used	Informative home visits are offered by local welfare organisations in various municipalities across the Netherlands. Within those municipalities, every person over 75 years is exposed
Group 2: initiatives aiming to detect problems (and needs) with regard to health and wellbeing in frail older people in order to optimize (current) delivery of health and social care a
3. Initiatives by GP practices [23, 24, 51, 70–74]	Older people living at home, who are at high risk of frailty. Age categories differ per initiative, e.g. people aged 65 and over; people aged 75 and over.	To identify frail older people in the population, and provide proactive care if necessary	Primary care	GP, nurse practitioner, community nurse. Other health and social care professionals if necessary, according to the problems that are identified.	Physical, psychological and social functioning	Design and execute a personal care and support plan	Varies per initiative: Screening methods for frailty, e.g. GP registries, screening instruments such as Groningen Frailty Indicator.	At least 8 types of initiatives were identified that were practiced in various locations in the Netherlands. The initiatives included approximately 170 practices and approximately 16.300 (frail) older people were exposed to the initiatives
							Screening instruments for problems and risks related to health, wellbeing and living circumstances, e.g. Resident Assessment Instrument, EASY-Care TOS
4. Initiatives in hospitals and during hospital transfers [22, 75, 76]	Patients over 65 who are at high risk for loss of function during hospitalisation	To prevent loss of function during and after hospitalisation	(Research) nurse in hospital	Geriatric nurse, transfer nurse, geriatrician, case manager. Other health and social care professionals if necessary, according to the problems that are identified	Preservation of functioning, self-reliance and quality of life	Delivery of proactive care during hospitalisation combined with coordinated after care after hospital discharge	Varies per initiative: ISAR-HP, VMS (for screening frailty). GAS-plan, geriatric assessment (for screening for problems and risks)	At least 2 types of initiatives were identified in hospitals in the south-west and north-west of the Netherlands. Based on these initiatives, a minimum of 500 older people were exposed to the initiatives
5. Initiative by health and social care professionals who visit older people at their homes [77]	Older people living at home who are frail or at risk of frailty	To early detect psychosocial problems and risks	Health and social care professionals who visit older people at their homes, e.g. nurse from a home care organization, VEA, community nurse	Professionals from municipal (mental) health care organization, nurse from a home care organization, VEA, community nurse	Psychosocial problems and risks (e.g. loneliness, depression, alcoholism, elderly abuse)	Referral to the required services for their psychosocial issues	Screening instruments are used by some professionals (e.g. the Geriatric Depression Scale, GDS). Professionals mostly use their “gut-feeling”	This initiative was identified in one area in the south-west of the Netherlands
6. Initiatives by community nurses/integrated neighbourhood approach [78–80]	Varies per initiative: the community in general. Some of the initiatives are targeted at frail older people	To gain insight into the problems and needs in a community and facilitate people to keep control over their own lives	Community nurse (sometimes in combination with other professionals that are active in the community, e.g. social workers, district policemen)	Various health and social care professionals, according to the problems and needs that are identified	Various domains. For older people mainly health, wellbeing, safety and living situation	Provision of information, practical support, after care; referral to other professionals; facilitation of involvement of family caregivers	In some initiatives screening instruments are used. An “open conversation” without using any instruments is often preferred.	Initiatives by community nurses are offered in various neighbourhoods across the Netherlands
7. Home visits by volunteer elderly advisors (VEA) [81, 82]	Older people needing help, who contacted the elderly organisation	To facilitate self-reliance by offering practical support and contacting professionals if necessary	Initiated by older person or someone in his social network	VEA, others professionals according to the problems and needs that are identified	Health, wellbeing, living circumstance, participation	Provision of advice and practical support	In some cases, a topic list is used, but screening instruments are mostly not used. An “open conversation” without using any instruments is preferred.	VEAs are active through elderly organisations or local welfare organisations in various municipalities across the Netherlands.
8. Home visits by municipalities (so-called “kitchen-table conversations”). [83]	Older people living at home who requested support from municipal services and facilities	To evaluate the extent to which older people are self-reliant and able to participate in society, the support they receive from their social network, and the care and support that would be necessary from the municipality. All intended to facilitate self-reliance and social participation.	Initiated by older person, possibly in consultation with professional	Several possibilities, but always commissioned by municipality: social care consultant of the municipality, employee from (social) welfare organization, client support organization, health care organization.	All life domains (e.g. living, working, income/debt, education, health, lifestyle, leisure activities, social activity, mobility, practical skills).	Provision of support from municipal social services (e.g. home care, adult day care services) if older people are not self-reliant or able to independently, or with the support from their social network, participate in society.	Varies per municipality, e.g. Self-reliance matrix (ZRM) and the Vitality Indicator	In principle in all municipalities in the Netherlands. However, due to large reforms of the long-term care system (that involve municipalities), not all municipalities are able to offer kitchen table conversations yet.

^aBased on their aims, the eight categories of initiatives can roughly be divided into two groups: 1. ‘initiatives aiming to detect older people at risk of deterioration in order to provide preventive interventions’ and 2. ‘initiatives aiming to detect problems (and needs) with regard to health and wellbeing in frail older people in order to optimize (current) delivery of health and social care’. It should, however, be noted that individual initiatives from certain categories from for instance group 2 would meet the objectives of group 1 more (and the other way around). This is mainly due to local variation in how the initiatives are being practiced