Cardiovascular prevention in older people: The preDIVA trial

In the Netherlands, the number of people aged 70 and above has increased in the previous decades, and will continue to do so in the coming years. Nowadays, older people are often healthy and active, and strive for a high quality of life. However, in an aging population new problems arise: many people have to deal with chronic conditions, functional decline and/or age-related diseases such as dementia, which have a huge impact on the lives of patients and their relatives, and society as a whole. The growing number of people with dementia and other disabling conditions such as heart failure or stroke poses new challenges for our healthcare system: we need to look for new ways of providing good care to the rising number of older people. The work presented in this thesis is written in the context of the preDIVA trial (prevention of dementia by intensive vascular care), which addresses these issues. PreDIVA is a cluster-randomized controlled trial in community-dwelling older people, aged 70 to 78 years at the start of the study. Its purpose is to assess the effect of nurse-led intensive vascular care on the incidence of dementia and disability in a primary care population, within a follow-up period of at least 6 years (study extension for those first included was obtained during the trial, leading to an extended follow-up period of 8 years in this group). All people from participating GP’s (general practitioners) were invited to participate in the study, except those already diagnosed with dementia, or with conditions that were likely to hinder follow-up (e.g. terminal disease, alcoholism). The target inclusion number of the study was 3600, based on an expected 8.3% incidence of dementia in this population. This study also provides an excellent opportunity to look at current cardiovascular risk management and prevalence of conditions like depression and apathy