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Physical Functioning of Older People in Primary Care

Qualitative Article
Purpose statement The development of a proactive care program which is carefully-structured program that provides physical functioning enhances the quality of life for the frail older people.
Problem statement Currently, the primary care of older people has some limitations. It is reactive, fragmented, and time-consuming. There are many complaints from both the caregivers and the patients (Bleijenberg et al., 2013).
Literature Review It required a systematic literature search to discover assessments, nursing interventions, and patient recommendations in meta-analyses and systematic reviews. The searches involved PubMed, PsychINFO, Cumulative Index to Nursing, and Allied Health Literature, and the Cochrane Library Databases. The review period was between January 2000 and January 2010. The Dutch Institute for Healthcare Improvement graded the methodological quality and level of evidence. The review included about 11systematic reviews and meta-analyses for each geriatric condition
Framework or Theoretical Perspective The first step of the U-CARE program relied upon the literature, clinical experiences, and the discussions of the multidisciplinary team of researchers and practitioners. It started by choosing the appropriate methods. The study had to choose the target as the older patients at risk of functional decline, patient needs, evidence-based research and feasibility in clinical practice. The method also had the development phase, development frailty assessment, the development CGA and evidence-based care plans, literature review, review of the guidelines and face validity assessments. The study also required the gathering of expert opinion, and feasibility study. The next stage was the analysis, preparation and delivery of the results. There was the need to discuss them and conclude the research. It gives the direction on how to effect the process of the U-CARE program. The MRC framework is the theoretical guide for the new program. The study combined the framework with the guiding principles and hence led to the improvement of the developmental process of the U-CARE intervention. Reporting helps to understand the fundamental principles and enhance its reliability in future when other institutions replicate the design. It gives credence to the proactive, structured, and integrated approach in primary care.
Research questions and hypotheses The hypothesis was to study the older patients at the risk of functional decline, and assess whether the new U-CARE program can become useful for addressing their concerns. The questions addressed the biological, psychological, social and experiences with the healthcare system concerns.
Variables (dependent & independent)
Demographic variables
The previous research, questionnaire forms, the elderly, and nurses were dependent variables.
Demographic variables were the hospitals and homes from where the elderly could answer the questions.
Appropriateness of Design
The research followed the already established patterns for finding evidence (Bleijenberg et al., 2013). For instance, the literature review and previous successful attempts helped to give the correct framework for the success of the U-CARE program.
Validity of the Research The study met all the predefined components of CGA. The U-CARE intervention plans will seek to provide critical care to improve the condition of the elderly.
Efficacy of the study
Were questions resolved
The complaints about time, finance, and lack of capacity were addressed during the study. The care programs for the frail older people were of particular interest during the development of the program.
Legal & Ethical issues
Human subject protection
The University of Applied Sciences Utrecht from Netherlands addressed all ethical and legal matters appropriately. The Protocol ID was 10-149/0. The Netherlands Trial Register Number was NTR2288.
Cultural aspects There was no need to address culture since the frailty condition affected most of the old people from all cultures.
Sample It involved 122 General Practitioners and 21 Registered Practice Nurses. It also included 3,000 patients in and around Utrecht in Netherlands (Bleijenberg et al., 2013). A small pilot study helped to enhance its acceptability. It contributed to identification of the various uncertainties in the implementation of U-CARE. It involved three experienced registered practice nurses from different general practices. Thirty patients were also part of the pilot project in the six weeks period.
Describe procedures The study involved the following procedures:
  1. Development phase.
  2. The Chronic Care Model
  3. The frailty assessment
  4. The development of the CGA and evidence-based care plans.
  5. The literature review
  6. The analysis to gather expert opinion to resolve any conflicting or divergent thoughts (Bleijenberg et al., 2013).
  7. Feasibility stage
Describe results The results should be available to the nurses in a specially developed web-based design. Patients with more than four GFI score should get the CGA at home.
How results of research may impact future nursing practice The hospitals and nurses need to develop a U-CARE program in the institution to carter for the elderly. Hospital and other medical institutions can provide a step by step approach to the development of the new program. They need to follow the literature and guideline reviews. They also need practical experiences, expert opinions, and target group evaluations.
Applies research to student’s nursing practice The nursing schools need to equip the students with the U-CARE knowledge. If they learn the principles while in school, they can easily understand and apply them in life. The research should be part of the syllabus for the nursing students. The study may seem time-consuming and costly, but it leads to the improvement of the accessibility and quality of the intervention. However, due to its multiple uses in various institutions, the cost will come down to affordable ranges.


Bleijenberg, N., ten Dam, V., Drubbel, I., Numans, M., de Wit, N., & Schuurmans, M. (2013). Development of a proactive care program (U-CARE) to preserve physical functioning of frail older people in primary care. Journal of Nursing Scholarship, 45(3), 230-237. Web.

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