Helge Garåsen The Trondheim Model - NSDM

workers, physiotherapists, occupational therapists and geriatricians working together
(162,167). The common assumption is that aging is a poorly understood biological process
that affects the manifestations of disease and recovery from illness.
There are numerous training programmes, inpatient and outpatient, in most Western societies.
Most of these programmes are based on specialised care provided at specialised departments
(10-11,167) or inpatient (12) or outward (outreach) teams (13-14,162-163). Outwards teams
typically run programmes in patients’ homes or at community based hospitals (13-14,162).
Care of older patients has during the passed 25 years shifted from care in general hospital
wards to care provided by specialised departments and specialised teams. At the same time
there is a growing awareness that a health system dominated by secondary, tertiary and
emergency care will tend to be fragmented, lacking in continuity, uncoordinated and costly
(2,48,108,167).
However, many of the geriatric programmes target areas that can be handled by professionals
other than physicians, and it may be that outward programmes provided by primary level
therapists could be a suitable alternative. There are some concerns that the gap between
primary and secondary care has been widened in the last few decades as the general hospitals
have been growing more and more specialised with an increasing number of subspecialists
whilst primary level has focused mostly on basic care needs and not so much on the patients’
potential to maintain or to achieve better mental and physical function (104).
6.6.1 Results on care level Study I and Study II
Study I has shown that two expert panels have agreed that one of six older patients above 75
years of age had low or intermediate benefits from a general hospital admission. The general
practitioners even assessed as much as four of ten, and these patients could probably have
been treated outside the general hospital if appropriate care programmes and/or institutions at
primary level had been available.
Study II has shown a decrease in readmissions to general hospital, an increase in the number
of patients independent of community care and an increase in survival at a lower cost when
prolonged care and/or rehabilitation are provided as intermediate care.
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