Yvonne Schoon appointed professor by special appointment 'The right care for the right older person' 

Yvonne Schoon has been appointed professor by special appointment 'The right care for the right older person' at the Radboudumc / Radboud University as of 1 October 2021. She develops methods to determine whether a treatment is appropriate for older people and whether they are resilient enough to undergo the treatment. Schoon argues that no treatment should also be a serious option and quality of life is more important than quantity of life. 

Due to aging of the population, both the number of older people and their life expectancy in the Netherlands is increasing. Also the differences between older people have become larger: some are still fit, while others are dealing with several diseases. At the same time, innovations in healthcare are quickly developing, offering more possibilities for diagnostics and treatment. As a result, health care professionals are treating older people more often, without knowing whether this is meaningful and appropriate care.

"Doctors see the possibilities and are eager to take action," says Yvonne Schoon, geriatrician at the Radboudumc. "But what do older people themselves consider important? Apparently this is mainly the quality of life. Not so much that people are getting older, but much more how they are getting older. Treatment involves risks and as a result people can become less independent or end up in a care facility due to complications or a long recovery phase. This creates a contrast between the doctor's commitment and the patient's wishes."  

Resilience

"The most important question in my work is: does healthcare always fit every older person? The answer is no." That is why Yvonne Schoon develops methods for so-called triage, enabling doctors to assess whether a treatment fits a patient. Schoon: "Healthcare today is organized in care pathways. In triage we look at whether a patient can follow a care path, whether the patient perhaps needs to become fitter before we start treatment, or whether we need an alternative to the care path."

Schoon is investigating what tools and tests are required for triage. "The process of triage in geriatric medicine has changed. As physicians, we mainly look at frailty of patients. Nowadays it also appears important to turn this perspective around and we actually assess resilience. The central question: is someone resilient enough for treatment? I am developing the necessary methods for this new approach, especially in acute care, oncological care and in cardiovascular disease." 

Appropriate methods

A good example is triage in aortic valve replacement. Yvonne Schoon explains: "We perform this operation mainly in people over seventy. We assess their general functioning and cognition. Another instrument we use to measure frailty is walking speed. This turns out to be a very suitable measure of frailty that we take into account in the final decision on the treatment plan. But for resolving a weak spot in an artery (aneurysm), walking speed is less suitable. Then we prefer to use a test such as sustained hand grip work, or we look at the speed of recovery in blood pressure after getting up from a lying position."

In this way, Schoon develops appropriate triage methods for different conditions. This not only helps to assess if a treatment is useful, but also provides information on the support needed during treatment. Furthermore, Schoon is committed having the new methods incorporated into national guidelines and is working to implement them in other hospitals. In this way, she hopes that all over the Netherlands more attention will be paid to useful and sustainable healthcare.

Career

Yvonne Schoon (Roermond, 1969) studied medicine in Maastricht. After her specialization she started as a geriatrician in 2002 and has been working at the Radboudumc since 2004. She obtained her PhD in 2013 on her thesis entitled 'From a gait and falls clinic visit towards self-management of falls in frail elderly'. In 2016, she was appointed Principal Clinician.

From 2015 to 2020, Schoon worked as head of the Emergency Department and since 2020 as department head a.i. in geriatrics. Since March 2021, she has been medical director elect of the new Center for Integrated Care. This center focuses on complex and personalized patient care. One of the aims is to involve both the patient and all the health care professionals in the process of decision making.

Appointment

The healthcare insurer VGZ contributes to this position. VGZ and Radboudumc have an alliance since 2015. The appointment is for a period of three years.

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