Prediction of institutionalization in the elderly. A systematic review

Long-term air pollution exposure and incident physical disability in older US adults: a cohort study

BACKGROUND

Disability is a key marker of overall physical health in older adults and is often preceded by chronic disease. Although air pollution is a well recognised risk factor for multiple chronic diseases, its association with physical disability has not been well characterised. We investigated the associations of air pollutants with physical disability in a large cohort representative of older adults in the USA.

METHODS

We used biennial data on incident activities of daily living (ADL) disability collected from respondents of the Health and Retirement Survey between 2000 and 2016. As part of the Environmental Predictors of Cognitive Health and Aging study, we estimated 10-year average PM2·5, PM10-2·5, nitrogen dioxide (NO2), and ozone (O3) concentrations at participant residences before each survey using spatiotemporal prediction models. We used a time-varying, weighted Cox model to estimate hazard ratios (HRs) for incident physical disability per interquartile increase of air pollution with detailed adjustments for confounders.

FINDINGS

Among 15 411 respondents aged 65 years and older (mean age 70·2 [SD 6·5] years; 55% female, 45% male), 48% of respondents reported newly having ADL disability during a mean follow-up of 7·9 years (SD 4·7). In fully adjusted models, we found greater risks of ADL disability associated with higher concentrations of PM2·5 (HR 1·03 per 3·7 μg/m³ [95% CI 0·99-1·08], p=0·16), PM10-2·5 (1·05 per 4·9 μg/m³ [1·00-1·11], p=0·022), and NO2 (1·03 per 7·5 ppb [0·99-1·08]. p=0·064), although not all these associations were statistically significant. In contrast, O3 was associated with a lower risk of ADL disability (0·95 per 3·7 ppb [0·91-1·00], p=0·030). In a multi-pollutant model, associations were similar to the single-pollutant models for PM10-2·5 (1·05 per 4·9 μg/m³ [1·00-1·11], p=0·041) and O3 (0·94 per 3·7 ppb [0·88-1·01], p=0·083).

INTERPRETATION

Our findings suggest that air pollution might be an underappreciated risk factor for physical disability in later life, although additional research is needed.

FUNDING

National Institutes of Environmental Health Sciences and National Institute on Aging.

Predicting the risk of nursing home placement of elderly persons using a population-based stratification score

OBJECTIVE

To develop and validate a novel score predictive of nursing home placement in elderly.

STUDY DESIGN

Population-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy.

METHODS

The 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration.

RESULTS

Twenty-one factors were identified as predictive of nursing home admission and were included in the "Elderly Nursing Home Placement" (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk.

CONCLUSIONS

A simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.

Prevalence of orofacial pain in individuals with mild cognitive impairment or dementia: A systematic review and meta-analysis

BACKGROUND

This systematic review investigated the prevalence of orofacial pain in patients with mild cognitive impairment (MCI) or dementia.

MATERIALS AND METHODS

The search was conducted in five databases (Medline (Ovid), Embase (Ovid), CINAHL, Scopus and LILACS), in three grey literature sources and in included articles' reference lists. Three independent reviewers performed study selection, quality appraisal and data extraction. The risk of bias was assessed with the National Institutes of Health tool. Prevalence was calculated using the random-effects model. Subgroup analysis and meta-regression were used to explore the heterogeneity of results.

RESULTS

The database and grey literature search led to 12 246 results, from which nine studies were included; a further four were selected through citation searching. The total sample comprised 6115 patients with dementia and 84 with MCI. All studies had high risk of bias. The overall estimated pooled prevalence of orofacial pain among dementia participants was 19.0% (95% CI, 11.0%-27.0%; I 2, 97.1%, P < .001). Only one study included MCI participants, among which the prevalence of orofacial pain was 20.5%. Subgroup analysis demonstrated that the different sources of diagnosis might explain the heterogeneity. A higher prevalence of orofacial pain was observed in dementia participants aged over 80 years or living in nursing homes. Meta-regression analysis showed a nonlinear relationship between age and the prevalence of orofacial pain.

CONCLUSIONS

The pooled data from the primary studies revealed that 2 out of 10 patients with dementia have orofacial pain. Further research is needed to clarify the magnitude in individuals with MCI.

Predicting informal dementia caregivers' desire to institutionalize through mining data from an eHealth platform

BACKGROUND

Dementia is a leading factor in the institutionalization of older adults. Informal caregivers' desire to institutionalize (DI) their care recipient with dementia (PwD) is a primary predictor of institutionalization. This study aims to develop a prediction model for caregivers' DI by mining data from an eHealth platform in a high-prevalence dementia country.

METHODS

Cross-sectional data were collected from caregivers registering on isupport-portugal.pt. One hundred and four caregivers completed the Desire to Institutionalize Scale (DIS) and were grouped into DI (DIS score ≥ 1) and no DI (DIS score = 0). Participants completed a comprehensive set of sociodemographic, clinical, and psychosocial measures, pertaining to the caregiver and the PwD, which were accounted as model predictors. The selected model was a classification tree, enabling the visualization of rules for predictions.

RESULTS

Caregivers, mostly female (82.5%), offspring of the PwD (70.2), employed (65.4%), and highly educated (M 15 years of schooling), provided intensive care (Mdn 24 h. week) over a median course of 2.8 years. Two-thirds (66.3%) endorsed at least one item on the DIS (DI group). The model, with caregivers' perceived stress as the root of the classification tree (split at 28.5 points on the Zarit Burden Interview) and including the ages of caregivers and PwD (split at 46 and 88 years, respectively), as well as cohabitation, employed five rules to predict DI. Caregivers scoring 28.5 and above on burden and caring for PwD under 88 are more prone to DI than those caring for older PwD (rules 1-2), suggesting the influence of expectations on caregiving duration. The model demonstrated high accuracy (0.83, 95%CI 0.75, 0.89), sensitivity (0.88, 95%CI 0.81, 0.95), and good specificity (0.71, 95%CI 0.56, 0.86).

CONCLUSIONS

This study distilled a comprehensive range of modifiable and non-modifiable variables into a simplified, interpretable, and accurate model, particularly useful at identifying caregivers with actual DI. Considering the nature of variables within the prediction rules, this model holds promise for application to other existing datasets and as a proxy for actual institutionalization. Predicting the institutional placement of PwD is crucial for intervening on modifiable factors as caregiver burden, and for care planning and financing.

Social inequity in ageing in place among older adults in Organisation for Economic Cooperation and Development countries: a mixed studies systematic review

BACKGROUND

Most older adults wish to remain in their homes and communities as they age. Despite this widespread preference, disparities in health outcomes and access to healthcare and social support may create inequities in the ability to age in place. Our objectives were to synthesise evidence of social inequity in ageing in place among older adults using an intersectional lens and to evaluate the methods used to define and measure inequities.

METHODS

We conducted a mixed studies systematic review. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and AgeLine for quantitative or qualitative literature that examined social inequities in ageing in place among adults aged 65 and older in Organisation for Economic Co-operation and Development (OECD) member countries. Results of included studies were synthesised using qualitative content analysis guided by the PROGRESS-Plus framework.

RESULTS

Of 4874 identified records, 55 studies were included. Rural residents, racial/ethnic minorities, immigrants and those with higher socioeconomic position and greater social resources are more likely to age in place. Women and those with higher educational attainment appear less likely to age in place. The influence of socioeconomic position, education and social resources differs by gender and race/ethnicity, indicating intersectional effects across social dimensions.

CONCLUSIONS

Social dimensions influence the ability to age in place in OECD settings, likely due to health inequalities across the lifespan, disparities in access to healthcare and support services, and different preferences regarding ageing in place. Our results can inform the development of policies and programmes to equitably support ageing in place in diverse populations.

Examination of reliability and validity of the Self-Assessment Burden Scale-Motor for community-dwelling older adults in Japan: a validation study

Background

The aging society in Japan is progressing rapidly compared with that in the United States and European countries. Aging limits activities of daily living (ADL) in older adults, declining their lives and functions at home. Therefore, improving their ADL to effectively support their functioning at home for as long as possible is vital. Consequently, supporters need to have a common understanding, be promptly aware of the decline in ADL, and quickly introduce rehabilitation. The Functional Independence Measure (FIM) and Barthel Index (BI) are the main scales used to quantitatively assess ADL. However, previous studies have reported that FIM requires specialized knowledge for evaluation, and BI does not appropriately capture changes in ADL. The Self-Assessment Burden Scale-Motor (SAB-M) was developed as a scale for family caregivers to appropriately assess changes in ADL in older adults. Previous studies using the SAB-M have confirmed its reliability and validity in hospitalized patients as assessed by their family caregivers. Therefore, this study aimed to investigate the reliability and validity of the SAB-M among community-dwelling older adults as assessed by their family caregivers.

Methods

This study included community-dwelling older adults who received home-visit rehabilitation at the first author's facility between October 2020 and December 2020 in Japan. Following previous studies, the SAB-M was used by family caregivers to assess 20 older adults twice for intra-rater reliability. Furthermore, 168 older adults were evaluated by family caregivers for internal consistency using the SAB-M. For criterion validity, the SAB-M was used for the assessment by family caregivers, and therapists used the FIM-Motor (FIM-M). This study used the weighted kappa, Cronbach's alpha, and Spearman's rank correlation coefficients for the statistical analysis of intra-rater reliability, internal consistency, and criterion validity, respectively.

Results

The weighted kappa coefficient for the total score was 0.98 (p < 0.01) and individual item, it was 0.93 for feeding (p < 0.01), 0.91 for bathing (p < 0.01), 0.98 for dressing (p < 0.01), 0.94 for transfer (p < 0.01), 0.94 for walking/wheelchair (p < 0.01), 0.95 for stairs (p < 0.01), and 0.96 for bladder management (p < 0.01). The Cronbach's alpha was 0.93 for the seven items. The Spearman's rank correlation coefficient between the SAB-M and FIM-M scores was 0.91 (p < 0.01).

Conclusion

The SAB-M has sufficient reliability and validity among community-dwelling older adults. Family caregivers can routinely assess changes in the ADL of community-dwelling older adults using the SAB-M, enabling them to promptly consider introducing rehabilitation when older adults' ADL declines. Therefore, implementing SAB-M helps older adults live and function at home for as long as possible.

The association between social risks and days at home for older veterans

BACKGROUND

Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed how social risks were associated with days at home for a cohort of older Veterans at high risk for hospitalization and mortality.

METHODS

A prospective cross-sectional study using a 2018 survey of 3479 high-risk Veterans aged ≥65 linked to Veterans Health Administration data. Social risks included measures of social resources (i.e., no partner present, low social support), material resources (i.e., not employed, financial strain, medication insecurity, food insecurity, and transportation barriers), and personal resources (i.e., low medical literacy and less than high school education). We estimated how social risks were associated with days at home, defined as the number of days spent outside inpatient, long-term care, observation, or emergency department settings over a 12-month period, using a negative binomial regression model.

RESULTS

Not having a partner, not being employed, experiencing transportation barriers, and low medical literacy were respectively associated with 2.57, 3.18, 3.39, and 6.14 fewer days at home (i.e., 27% more facility days, 95% confidence interval [CI] 8%-50%; 42% more facility days, 95% CI 7%-89%; 34% more facility days, 95% CI 7%-68%; and 63% more facility days, 95% CI 27%-109%). Experiencing food insecurity was associated with 2.62 more days at home (i.e., 24% fewer facility days, 95% CI 3%-59%).

CONCLUSIONS

Findings suggest that screening older Veterans at high risk of community exit for social risks (i.e., social support, material resources, and medical literacy) may help identify patients likely to benefit from home- and community-based health and social services that facilitate remaining in home settings. Future research should focus on understanding the mechanisms by which these associations occur.

Sex differences in physical functioning among older adults: cross-sectional results from the OUTDOOR ACTIVE study

BACKGROUND

Maintaining good functional ability is a key component of healthy ageing and a basic requirement for carrying out activities of daily living, staying independent, and delaying admission to a nursing home. Even though women have a higher life expectancy and slower age-related muscle mass loss than men, they often show a higher prevalence of limitations in physical functioning. However, the reasons behind these sex differences are still unclear. Therefore, the aims of this study were to investigate sex differences among older adults regarding physical functioning and to study which factors are explaining these sex differences.

METHODS

Cross-sectional data from participants of the OUTDOOR ACTIVE study residing in Bremen, Germany, aged 65 to 75 years, were included in the analyses. Physical functioning was assessed via a self-administered questionnaire using the SF-36 10-item Physical Functioning Scale. Social, lifestyle, and health-related factors were also assessed using the questionnaire. Physical activity was measured objectively using wrist-worn accelerometers over seven consecutive days. Descriptive analyses with absolute and relative frequencies, means and standard deviations, as well as T-tests and chi-square tests were carried out. To test for associations between sex, physical functioning, and several individual factors, linear regressions were performed.

RESULTS

Data of 2 141 participants (52.1% female) were included in the study. Women and men showed statistically significant differences in physical functioning, with men perceiving fewer limitations than women. On average, women had a physical functioning score of 81.4 ± 19.3 and men 86.7 ± 17.0. Linear regression showed a statistically significant negative association between physical functioning score and sex (β: -0.15, 95% CL: -0.19, -0.10). The association remained statistically significant when adding individual factors to the model. All factors together were only able to explain 51% of the physical functioning-sex association with health indicators and the presence of chronic diseases being the most influential factors.

CONCLUSIONS

We found sex differences in physical functioning, with older women having more limitations than older men. The results showed that health-related factors and chronic diseases played the biggest roles in the different physical functioning scores of women and men. These findings contribute to future longitudinal, more in-depth research.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018).

The Importance of Zero-Deficiency Complaints in Nursing Homes: A Mere Consequence or Serious Concern?

Complaints represent an important metric for assessing the quality of nursing home (NH) care. Using the Automated Survey Processing Environment (ASPEN) Complaints/Incidents Tracking System dataset (2017), we examined the relationships between zero-deficiency complaints (ZDCs) and zero-deficiency substantiated complaints (ZDSCs) and the proportion of residents with dementia. NHs (N = 15,339) were separated into three groups-proportion of residents with dementia in the top, two middle, and the bottom quartiles. Negative binomial regressions assessed zero-deficiency complaint patterns in relation to NHs' proportion of residents with dementia, controlling for facility characteristics, staffing, and racial pattern. We reported average marginal effects (AMEs) and 95% confidence intervals (CIs). NHs in the top quartile yielded higher numbers of both ZDC (AME = .189, 95% CI: .102-.276, p < .001) and ZDSC (AME = .236, 95% CI: .094-.378, p = .001), than NHs in the bottom quartile. Results suggest a need for more uniform investigation processes and staff training to promote a more valid complaint process for residents with dementia.

Longitudinal study of cognitive decline among women with and without urinary incontinence

BACKGROUND

Cross-sectional and short-term cohort studies have demonstrated an association between urinary incontinence and dementia, as well as lower performance on cognitive testing. The Health and Retirement Study, a longitudinal study of community-dwelling older adults, offers an opportunity to assess the temporal association between these conditions because it included an assessment of incontinence symptoms and biennial assessments of cognitive function.

OBJECTIVE

This study aimed to evaluate if urinary incontinence before the age of 70 years had an effect on changes in cognitive function among women participating in the Health and Retirement Study.

STUDY DESIGN

This secondary analysis included data from female respondents in the Health and Retirement Study aged 58 to 67 years with ≥2 cognitive assessments. Urinary incontinence was defined as any involuntary loss of any urine in the preceding 12 months. A control group without incontinence was reweighted for better comparability using coarsened exact matching for age and comorbidities. Validated methods, including neuropsychological test data, estimated a memory score and dementia probability for each participant biennially. Coprimary outcomes were the changes in memory score and dementia probability. Linear regression models were used to estimate the association of urinary incontinence with change in memory score and dementia probability, adjusting for baseline demographics and comorbidities. A subgroup analysis was performed to assess the effects of urinary incontinence frequency on these outcomes. The infrequent subgroup reported <15 days of leakage per month and the frequent subgroup reported ≥15 days of leakage per month.

RESULTS

Among eligible female respondents, 40.6% reported urinary incontinence between the ages of 58 and 69 years. Baseline memory scores and dementia probability were similar between those with urinary incontinence (n=1706) and controls (n=2507). Memory score declined significantly in both cohorts, indicating poorer memory over time (-0.222 among those with incontinence [95% confidence interval, -0.245 to -0.199] vs -0.207 in controls [95% confidence interval, -0.227 to -0.188]). The decline of memory score was not statistically significantly different between cases and controls (mean difference, -0.015; 95% confidence interval, -0.045 to 0.015). Dementia probability increased significantly in both groups, indicating a greater probability of developing dementia by 0.018 among those with incontinence (95% confidence interval, 0.015-0.020) and by 0.020 among controls (95% confidence interval, 0.017-0.022). The change in dementia probability was not significantly different between groups (mean difference, -0.002; 95% confidence interval, -0.006 to 0.002). Frequent urinary incontinence was reported in 105 of 1706 (6%) of those with urinary incontinence. Memory score declined and dementia probability increased with time (P<.001) in frequent and infrequent urinary incontinence subgroups. There was no dose-response relationship.

CONCLUSION

Measures of cognitive performance declined during approximately 10 years of observation. The changes in performance were not associated with the presence of urinary incontinence in the participants' younger years.

Impact of Care-Recipient Relationship Type on Quality of Life in Community-Dwelling Older Adults With Dementia Over Time

INTRODUCTION

Maintaining quality of life (QoL) has been identified as the primary goal of care services for person living with dementia (PLWD).

METHODS

A secondary analysis was conducted on five rounds of the National Health and Aging Trends Study (NHATS) over 4 years. A generalized estimating equation (GEE) was used to examine the prediction of relationship type on older adults' QoL through four domains: mental health, general health, functional limitations, and pain.

RESULTS

older adults cared for by an adult-child or multiple caregivers predicted increased risk for functional limitations after adjustment for their socio-demographic and dementia status (IRR = 1.53, CI [1.26, 1.86]; IRR = 1.36, CI [1.14, 1.61], respectively). The interaction between the relationship type and education was significant. Older adults with a high school education or below, who were cared for by an adult child, had a significantly higher risk of increasing functional limitations over 4 years compared to those cared for by a spouse/partner (contrast = .50, P = .01, 95% CI [.07, .93]; contrast=.52, P = .03, 95% CI [.03, 1.02]; respectively). Similarly, older adults with a high school education, who were cared for by multiple caregivers, also experienced a significantly higher risk of increasing functional limitations than those cared for by a spouse/partner (contrast = .44, P = .03, 95% CI [.02, .85]).

CONCLUSION

Our findings provide evidence of the significant contribution of relationship type on PLWD's QoL changes over time. They also help to prioritize resource allocation while addressing PLWD's demands by socio-demographics such as education level.

Reciprocal and Dynamic Associations between Social Isolation, Loneliness, and Disability among Chinese Older Adults

OBJECTIVES

This study aimed to examine reciprocal and dynamic associations between Social Isolation (SI), loneliness, and disability among Chinese older adults.

DESIGN

This is a prospective cohort study.

SETTING AND PARTICIPANTS

The global trend of population aging has resulted in a significant rise in the prevalence of disabilities, SI, and loneliness among older adults. These factors can severely impact the health and well-being of older adults. Therefore, it is crucial to implement more efficient interventions aimed at reducing disabilities, addressing SI, and combating loneliness among older adults in order to improve their overall health and well-being.

METHODS

Using a large, nationally representative sample spanning 16 years, we employed the general cross-lagged panel model to explore the relationships among 50,348 older adults with a mean age of 81.83 at baseline. Disability was measured by a comprehensive index tool that incorporated multiple dimensions. SI was measured using an SI index, and loneliness was evaluated using a single-item measure.

RESULTS

SI emerged as a stronger predictor of disability than loneliness. Longitudinal analysis revealed accumulative disadvantages in the association between SI and disability. Additionally, disability was found to contribute to increased SI and loneliness. However, our study did not detect any variance in the strength of the cross-lagged effects between social isolation and disability.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that reducing SI is crucial for reducing disability among older adults. Initiating early interventions to minimize initial SI could aid in preventing later-life disability. Additionally, addressing disabilities may positively impact the reduction of loneliness and SI within this population.

Epidemiology of Faecal Incontinence for People with Dementia Living in the Community in New Zealand: A Retrospective Cohort Study Using interRAI Home Care Assessment Data

INTRODUCTION

Globally, there are few studies but wide variation in the epidemiology of faecal incontinence (FI) for people living with dementia in the community. Our objectives are to identify 1-year period prevalence, 5-year incidence, and risks for FI for people living with dementia.

METHODS

A retrospective cohort study comprising the International Residential Assessment Instrument Home Care version (interRAI-HC) assessments in a 5-year period in New Zealand (N = 109,964). For prevalence analysis, we selected a dementia cohort for a 1-year period from August 1, 2020, to July 31, 2021 (n = 7,775). For the incidence analysis, participants in the dementia cohort were followed up from the day of the first dementia diagnosis during the period August 1, 2016, and July 31, 2021. Dementia was identified by combining diagnosis of "Alzheimer's disease" and "Dementia other than Alzheimer's disease." Participants were coded with faecal incontinence if they were continent with a stoma, seldom incontinent, occasionally incontinent, often incontinent and incontinent.

RESULTS

One year period (1 August 2020-31 July 2021) prevalence of FI was 26.7% (2,082/7,775) of people with dementia. 5-Year incident FI rate was 19.0 per 100 person-years for people with dementia and 12.3 per 100 person-years for people without dementia. Controlling for risk factors for FI in both groups the hazard ratio for FI was 1.7 for people with dementia.

CONCLUSION

FI affects a significant proportion of people with dementia in New Zealand. interRAI-HC data could facilitate global epidemiological studies to estimate service or intervention needs for people with dementia to redress or manage FI.

Do Health and Housing Attributes Motivate Residential Moves Among Older Chinese Adults? Evidence From an 8‑Year Follow‑up Study

Background and Objectives

Despite the widespread belief in aging-in-place as the preferred housing arrangement for older adults, they are increasingly embracing moving. The person-environment fit theory explains that environmental changes due to residential moves can pose health risks, discouraging older people from moving. However, it also suggests that moves may be suitable when living conditions no longer meet their physical needs. The correlation between older people's health, housing, and their subsequent moving or staying actions in China remains underexplored.

Research Design and Methods

Using alternative operating variables of key concepts and the China Family Panel Studies 2012-2018 data sets, this study examines the effects of health and housing status on older people's residential moves in China. The study outlines changes in health indicators and housing characteristics during multiple moves, as well as examines the relationship between the health and housing status of older adults and moving over a relatively long period of time using both regression models with lagged explanatory variables and fixed effects binary choice models.

Results

The results reveal that: (1) higher rates of subsequent moves were observed among older adults with better self-rated health, positive self-rated health changes, and no ADL impairment, but no significant associations were found between most health variables and moving; and (2) the correlation between older persons' house ownership/type and their residential moves was significant and consistent over time, steady and lasting.

Discussion and Implications

Potential mechanisms explaining the association between specific housing types and ownership statuses on moving are discussed. The findings encourage a focus on the positive benefits of moving in later life and how to provide additional housing options for older individuals.

Longitudinal Care Network Changes and Associated Healthcare Utilization Among Care Recipients

This study examines caregiver networks, including size, composition, and stability, and their associations with the likelihood of hospitalization and skilled-nursing facility (SNF) admissions. Data from the National Health and Aging Trends Study linked to Center for Medicare and Medicaid Services data were analyzed for 3855 older adults across five survey waves. Generalized estimating equation models assessed the associations. The findings indicate each additional paid caregiver was associated with higher adjusted risk ratios (aRR) for hospitalization (aRR = 1.24, 95% CI 1.10-1.41) and SNF admission (aRR = 1.28, 95% CI 1.06-1.54) among care recipients, a pattern that is also observed with the addition of unpaid caregivers (hospitalization: aRR = 1.13, 95% CI 1.06-1.20; SNF: aRR = 1.12, 95% CI 1.02-1.23). These results suggest that policies and approaches to enhance the quality and coordination of caregivers may be warranted to support improved outcomes for care recipients.

Predicting short- to medium-term care home admission risk in older adults: a systematic review of externally validated models

INTRODUCTION

Predicting risk of care home admission could identify older adults for early intervention to support independent living but require external validation in a different dataset before clinical use. We systematically reviewed external validations of care home admission risk prediction models in older adults.

METHODS

We searched Medline, Embase and Cochrane Library until 14 August 2023 for external validations of prediction models for care home admission risk in adults aged ≥65 years with up to 3 years of follow-up. We extracted and narratively synthesised data on study design, model characteristics, and model discrimination and calibration (accuracy of predictions). We assessed risk of bias and applicability using Prediction model Risk Of Bias Assessment Tool.

RESULTS

Five studies reporting validations of nine unique models were included. Model applicability was fair but risk of bias was mostly high due to not reporting model calibration. Morbidities were used as predictors in four models, most commonly neurological or psychiatric diseases. Physical function was also included in four models. For 1-year prediction, three of the six models had acceptable discrimination (area under the receiver operating characteristic curve (AUC)/c statistic 0.70-0.79) and the remaining three had poor discrimination (AUC < 0.70). No model accounted for competing mortality risk. The only study examining model calibration (but ignoring competing mortality) concluded that it was excellent.

CONCLUSIONS

The reporting of models was incomplete. Model discrimination was at best acceptable, and calibration was rarely examined (and ignored competing mortality risk when examined). There is a need to derive better models that account for competing mortality risk and report calibration as well as discrimination.

Regional Variation in Lifetime Probability of Admission to Residential Aged Care in Australia

OBJECTIVES

This paper aims to apply a novel demographic technique to update - and extend to sub-national regions - estimates of the lifetime probability of admission to residential aged care.

METHODS

Making optimal use of Australian data sources on aged care usage, mortality and population, this study adopts a two-population life table approach to produce an updated set of national probability estimates and first-time regional estimates.

RESULTS

The probability of admission generally increases with age: nationally, lifetime probability at age 65 is 50% for women and 37% for men, rising to 55% and 46%, respectively, at age 85. This general pattern varied somewhat across regions.

DISCUSSION

The regional results point to inequities in the uptake of care, thereby informing providers, governments, aged care advocates and anyone interested in equity of access.

Social Mobility and Health-Related Quality of Life Trajectory Classes Among Older Women and Men

OBJECTIVES

Changes in socioeconomic status (SES) during life may impact health in old age. We investigated whether social mobility and childhood and adulthood SES are associated with trajectories of health-related quality of life (HrQoL) over a 17-year period.

METHODS

We used data from the Helsinki Birth Cohort Study (n = 2003, 46% men, mean age 61.5 years). Social mobility was derived from childhood SES, obtained from healthcare records, and register-based adulthood SES.

RESULTS

Logistic regression models showed that lower adulthood SES was associated with lower physical HrQoL trajectories. Among men low (OR 3.95, p < .001), middle (OR 2.20, p = .006), and declining lifetime SES (OR 2.41, p = .001) were associated with lower physical HrQoL trajectories compared to men with high SES. Socioeconomic status was not associated with mental HrQoL trajectories.

DISCUSSION

Declining SES during life course may have negative health consequences, while improving SES is potentially as beneficial as high SES to later-life health among men.

Factors influencing the length of stay in forensic psychiatric settings: a systematic review

BACKGROUND

Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions.

METHODOLOGY

A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported.

RESULTS

A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS.

CONCLUSION

High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research.

Do nursing homes with a higher proportion of residents with dementia have greater or fewer complaints?

Objectives: Nursing home (NH) residents' capacity to communicate deteriorates with dementia. Consequently, NHs with high proportions of people living with dementia (PLWD) may receive fewer resident complaints, and/or investigating complaints may be challenging. We assessed NHs' proportion of PLWD in relation to total and substantiated complaints. Methods: Data were from the ASPEN Complaints/Incident Tracking System and the Certification and Survey Provider Enhanced Reports (2017). NHs (N = 15,499) were categorized based on high (top-10%), medium (middle-80%), and low (bottom-10%) dementia prevalence. Negative binomial Poisson regression assessed complaint patterns in relation to NHs' high/low (vs. medium) proportions of PLWD and other facility/resident characteristics. Results: Compared to NHs with medium-dementia prevalence, NHs with low proportions of PLWD had higher total (average marginal effect [AME] = 0.16, p < 0.001) and substantiated (AME = 0.30, p < 0.001) complaints, whereas NHs with high proportions of PLWD had fewer total (AME= -0.07; p < 0.05) and substantiated (AME= -0.11, p < 0.05) complaints. Also, NHs' profit status, chain-affiliation, size, staffing, and resident ethnicity were associated with total and substantiated complaints. Conclusion: The association between high proportions of PLWD and lower NH complaints suggests either that these NHs have higher overall quality or that complaints are underreported. Regardless, surveyors and families may need more involvement in monitoring higher dementia prevalence facilities.

The factors affecting acceptance of gerontechnological products by older Turkish adults

This study investigates the attitudes of Turkish older people towards the acceptance of gerontechnological products. It included a total of 871 older individuals aged 65 and above from seven geographical regions of Türkiye. A questionnaire adopted from previous studies was applied to collect the data. The use of products of the older people was studied under the headings of (i) home and daily life technology, (ii) communication technology, (iii) health technology and (iv) education and recreation technology. As a result of the factor analysis, 16 questions were classified under: "attitudes towards using technology (AUT), facilitating conditions (FC), perceived ease of use (PEU) and gerontechnology anxiety (GA)". The effect of independent variables on the use of gerontechnological products was investigated by one-way variance analysis, and the relationship between the use of neurotechnological products and the attitudes of the older people towards accepting gerontechnological products was investigated by correlation analysis. Region, place of residence, age, gender, education level, economic and health status were found to be important in use gerontechnological products (p < 0.05). There was a high correlation between product groups as well as between product groups and attitudes. Results can be utilized in the production and dissemination of gerontechnological products to increase the level of life quality of the older people.

Bidirectional and dynamic relationships between social isolation and activities of daily living among older adults in China

Background

Social isolation and disability in performing activities of daily living are increasingly recognised as significant public health concerns globally. We aimed to investigate their bidirectional associations and the related temporal dynamics in Chinese older adults.

Methods

We retrieved data from the six waves of the Chinese Longitudinal Healthy Longevity Survey (2002-18) and used generalised cross-lagged modelling (GCLM) to assess the bidirectional associations between social isolation and disability in performing activities of daily living.

Results

We found that higher levels of social isolation were predictive of increased scores in disabilities in performing activities of daily living. Conversely, disabilities in performing activities of daily living showed less predictive power in relation to social isolation. The temporal dynamics analysis indicated a peak in the bidirectional associations after approximately six years, followed by decreasing trends.

Conclusions

Our results indicate that social isolation is dominant in the bidirectional relationship. Efforts focusing on reducing it can potentially minimise disabilities in performing activities of daily living among older adults. Reinstating preventive interventions beyond the six-year mark could help maintain their effectiveness.

A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review

This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.

Home Health Agencies With High Quality of Patient Care Star Ratings Reduced Short-Term Hospitalization Rates and Increased Days Independently at Home

BACKGROUND

Critics argue that Medicare's Quality of Patient Care home health star ratings are inaccurate. Valid ratings are essential to help patients find high-quality care.

OBJECTIVE

The aim of this study was to determine whether using the highest-rated home health agency available in a ZIP code improves outcomes.

RESEARCH DESIGN

A retrospective study of 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. An instrumental variables approach is used to address the endogeneity of agency choice, where the instrument is the differential proximity of the patient to the closest highest-rated and closest lower-rated agency.

OUTCOMES

Days independently at home; health care setting-specific days and death; hospitalization, emergency department use, and institutionalization risk.

RESULTS

Treatment by the highest-rated agencies available decreased risks (in percentage points) of hospitalization (-3.2; 95% CI, -4.1 to -2.3), emergency department use (-2.2; 95% CI, -3.2 to -1.1), and institutionalization (-0.9; 95% CI, -1.3 to -0.5) during the initial episode, and increased days independently at home by 2.6% or 3.75 (95% CI, 2.20-5.29) days in the 180 days after the end of the initial episode. Treatment effects were more pronounced for agencies that were above-average (6.51 d; 95% CI, 4.15-8.87), had ≥1 more star than the next-best agency (7.80 d; 95% CI, 4.13-11.47), and nonrural residents (4.57 d; 95% CI, 2.75-6.40). Effects were positive for both postacute (3.40; 95% CI, 1.80-5.00) and community-entry (5.60; 95% CI, 2.30-8.89) patients.

CONCLUSIONS

Medicare's Quality of Patient Care star rating correlates with reduced short-term hospitalizations and emergency department use and increased days independently at home in the longer term.

Predictors of Nursing Home Placement in a Cohort of European People with Alzheimer's Disease and Other Dementia Cases Enrolled in SCU-B or Non SCU-B Centers: The RECage Study

Background

Nursing home placement (NHP) can be the final step of patients with Alzheimer's disease.

Objective

We aimed to identify NHP predictors among 508 people with dementia with a 3-year follow-up.

Methods

We analyzed data from the international observational RECage study, involving 508 people with especially Alzheimer's disease and comparing a cohort enrolled by five centers with a Special Care Unit for BPSD (behavioral and psychological symptoms of dementia) and another one enrolled by six centers lacking this facility. The tertiary objective of the study was to assess the possible role of the SCU-B in delaying NHP. We assessed the relationship of the baseline characteristics with NHP by means of univariate analysis followed by Cox's multivariate model.

Results

Patients' mean age was 78.1 years, 54.9% were women. Diagnosis mean age was 75.4 (±8.32) years; the main diagnosis was Alzheimer's disease (296; 58.4%). During follow-up, 96 (18.9%) patients died and 153 (30.1%) were institutionalized without a statistically significant difference between the two cohorts (p = 0.9626). The mean NHP time was 902 (95% CI: 870-934). The multivariable analysis without death as a competing risk retained four independent predictors of NHP: age increase (hazard ratio (HR) = 1.023, 95% CI: 1.000-1.046), patient education level increase (HR = 1.062, 95% CI: 1.024-1.101), Neuropsychiatric Inventory total increase (HR = 1.018; 95% CI: 1.011-1.026), and total Mini-Mental State Examination as a favorable factor (HR = 0.948, 95% CI: 0.925-0.971). Gender (females versus males: HR = 1.265, 95% CI: 0.899-1.781) was included in the final Cox's model for adjusting the estimates for.

Conclusions

Our data partially agree with the predictors of NHP in literature including the effect of high education level. No caregivers' factors were statistically significant.

Clinical trial registration

NCT03507504.

Resistance Training on an Outdoor Exercise Structure Improves Lower-Body Relative Strength in Older Adults

Improving relative strength is important for maintaining functionality with age, and outdoor exercise structures could be useful to facilitate this. A total of 29 adults aged 65+ participated in a non-randomized crossover study with a 6-week control followed by a 6-week resistance training intervention on an outdoor exercise structure (3x/week). Relative strength (predicted maximal leg press/lower body lean mass [Dual-energy X-ray Absorptiometry]) and physical function variables were measured at baseline, post-control, and post-intervention. Represented as median (25th-75th), lower body relative strength improved from 7.91 (7.01-9.35) post-control to 8.50 (7.99-9.72) post-intervention (p = .002) in study completers (n = 17). Maximum leg press (p = .002), 30-second chair stand (p < .001), one-leg stance (p = .011), and maximum chest press (p = .009) also improved significantly during the intervention. There were no significant changes in aerobic activity, grip strength, lean mass, or muscle power. This study demonstrates that there could be potential relative strength benefits associated with the use of outdoor exercise structures in older adults.

Life-course socio-economic status and its impact on functional health of Portuguese older adults

Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013-2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β = -9.75; 95% CI: -14.34; -5.15; SF-36 mental health: β = -7.33; 95% CI: -11.55; -3.11; handgrip strength: β = -1.60; 95% CI: -2.86; -0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.

The role of functioning in predicting nursing home placement or death among older home care patients

OBJECTIVE

There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients.

DESIGN

A prospective one-year follow-up study.

SETTINGS AND SUBJECTS

Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293).

MAIN OUTCOME MEASURES

Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15).

RESULTS

Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62-0.86), IADL (0.75, 0.65-0.87) MMSE (0.92, 0.87-0.96), and TUG (1.02, 1.01-1.03). NHP alone was predicted by BADL (0.62, 0.50-0.78), IADL (0.57, 0.45-0.73), and MMSE (0.88, 0.82-0.94) and mortality by TUG (1.02, 1.01-1.03).

CONCLUSION

Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.

Factors associated with entry to residential care in frail older inpatients

OBJECTIVE

To examine factors that may influence the risk of discharge to a residential aged care facility (RACF) in a population of frail older inpatients.

METHODS

We analysed data from 5846 inpatients aged over 60 years from 27 hospitals in Queensland, Australia, admitted from independent living and referred for geriatric consultation. Patients underwent an interRAI Acute Care Comprehensive Geriatric Assessment by trained nurses. Frailty was assessed using a 52-item frailty index (FI). Risk/protective factors were determined a priori. Logistic regression assessed the relationship between factors and discharge destination, adjusted for FI, age, sex and hospital. Frailty × risk/protective factor interactions were performed.

RESULTS

Patients had a mean (SD) age of 79.7 (8.2) years and a mean (SD) FI of 0.44 (0.14). Twenty-nine per cent (n = 1678) of patients were discharged to an RACF. Each 0.1 increment in FI increased the risk of discharge to an RACF by 54% (OR 1.54, 95% CI 1.40-1.68, p < 0.01). Being married or in a de facto relationship had protective effects up to an FI of 0.7, whereas behavioural and psychological symptoms of dementia (BPSD) increased the risk of RACF discharge up to an FI of 0.7. Female sex, faecal incontinence and living alone did not influence the relationship between frailty and discharge destination.

CONCLUSIONS

The association between frailty and discharge to RACF has previously been recognised but here we found that risk and protective factors can influence this association. Whether early identification and management of mutable factors can reduce discharge to RACF should be addressed in future studies.

Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study

BACKGROUND

Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group.

METHODS

Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of 'severe' multimorbidity (defined as the presence of five or more chronic diseases).

RESULTS

The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02-1.06]).

CONCLUSIONS

The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.

Functional and Psychosocial Profile of Older People Living in Nursing Homes: Findings from the European Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

This paper is based on results from the Survey of Health, Ageing and Retirement in Europe (SHARE), exploring many aspects (health, economic situation and welfare) of the European population aged 50+. Differently from many other international studies, SHARE includes persons living in nursing homes or residential care facilities as part of its sample. The aim of this paper is to provide a socio-demographic, functional and psychosocial snapshot of older residents in nursing homes in Europe.

METHODS

This paper uses data from SHARE Wave 8/2020, carried out in 27 European countries. A quantitative/descriptive approach explores the prevalence of older people aged 65+ living in residential facilities as mapped by the SHARE survey across Europe, with regard to associated dimensions, i.e., socio-demographic, family relationship, perceived health/main diseases, functional and psychological status.

RESULTS

These show that older residents live mainly in Central and Northern Europe, are aged 80+, female and widowed. A small social network (SN) size is often reported. Health is perceived, above all, as being fair-poor, and the presence of long-term illness is high, with several chronic health conditions and functional limitations. The reported quality of life (QoL) is low for most respondents, with moderate-low satisfaction with life.

CONCLUSION

The analysis depicts a profile of seniors needing residential care in Europe, and provides useful insights for policymakers, to better sustain this frail population group, and to allow and improve access to high-quality long-term care (LTC) in Europe. Our findings could also be of help to train health professionals, and potentially drive the research towards the exploration of new housing solutions for seniors. This would in turn contribute to the effective implementation of European initiatives to strengthen LTC systems.

SARS-CoV-2 vaccine breakthrough infection in the older adults: a meta-analysis and systematic review

BACKGROUND

Corona Virus Disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) has recently declined, and reports about COVID-19 breakthrough infection have increased. We aimed to conduct a meta-analysis on population-based studies of the prevalence and incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection amongst older adults worldwide.

METHODS

Studies from PubMed, Embase, Cochrane Library, and Web of Science were systematically screened to determine the prevalence and incidence of SARS-CoV-2 breakthrough infection in older adults from inception to November 2, 2022. Our meta-analysis included 30 studies, all published in English. Pooled estimates were calculated using a random-effect model through the inverse variance method. Publication bias was tested through funnel plots and Egger's regression test, and sensitivity analyses were performed to confirm the robustness of the results. This research was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Thirty publications were included in this meta-analysis (17 on prevalence, 17 on incidence, and 4 on both). The pooled prevalence of COVID-19 breakthrough infection among older adults was 7.7 per 1,000 persons (95% confidence interval [95%CI] 4.0-15.0). At the same time, the pooled incidence was 29.1 per 1000 person-years (95%CI 15.2-55.7).

CONCLUSIONS

This meta-analysis provides estimates of prevalence and incidence in older adults. We concluded that the prevalence and incidence of SARS-CoV-19 breakthrough infection in older people was low. The prevalence and incidence of breakthrough infection admitted to hospital, severe-critical, and deathly was significantly lower. Otherwise, there was considerable heterogeneity among estimates in this study, which should be considered when interpreting the results.

Effects of Care Arrangement on the Age of Institutionalization among Community-dwelling Chinese Older Adults

Early and unnecessary institutionalization of older adults can be a heavy burden on the country and taxpayers. It is crucial to understand factors impacting the age of institutionalization of older adults in China. This study examined care arrangements of older adults in China and the relationship between these arrangements and the age of relocation to long-term care facilities (institutionalization). Results show that care arrangements affect the age of institutionalization among community-dwelling Chinese older adults. Those who were primarily cared for by sons and daughter-in-laws tended to be institutionalized at a significantly later age compared to those who were cared for by their spouses. Those who were primarily cared for by other relatives and friends, by domestic helpers, and those with no caregivers tended to have significantly earlier institutionalization compared to those who were cared for by their spouses. However, the number of older adults living in empty nest families is increasing rapidly. Traditional family support for older adults has been shrinking due to fewer children, out-migration of adult children from rural to urban areas, and increased employment of women in China. There is an acute shortage of competent and qualified elder care workers. Most Chinese domestic helpers started their work with limited or even no training, risking the safety of themselves and their employers. In addition to increasing and optimizing the investment in the elder care industry, legal protection and policy support for the elderly and domestic helpers are urgently needed to address these key issues.

Increasing physical activity levels in care homes for older people: a quantitative scoping review of intervention studies to guide future research

PURPOSE

Physical activity (PA) levels in older care home residents are low. This has detrimental effects on health. Little is known about the nature of interventions to increase physical activity in this population.

METHODS

A scoping review to: (1) identify and describe interventions to increase PA in older care home residents, and (2) describe the extent to which interventions address care home context, systemised by social-ecological models. We systematically searched databases for peer-reviewed intervention studies to increase PA in older people resident in care homes. Data were extracted using the template for intervention description and replication (TIDieR) and mapped against a social-ecological framework to locate the intervention focus.

RESULTS

The 19 included studies consisted of interventions tested in randomised or quasi-experimental trial designs. Interventions consisted of single or multiple components and predominantly addressed individual resident level factors (such as muscle strength) rather than broader social and environmental aspects of context. Interventions were not all fully described. For most interventions a distinct theoretical foundation was not identified. Interventions were mostly delivered by health professionals and research staff external to care homes.

CONCLUSIONS

Future interventions should address contextual care home factors and should be clearly described according to intervention description guidance.Implications for rehabilitationPhysical activity holds promise as an effective means of improving health and function in older care home residents, but physical activity levels in this population are low.Several reasons beyond the individual resident but related to care home contextual factors may explain low PA in care homesTo date, contextual factors influencing PA in care homes have been poorly addressed in interventions.Wider care home context (social, cultural, and environmental factors) must be considered in future interventions.

Factors Influencing Older Persons' Transitions to Facility-Based Care Settings: A Scoping Review

BACKGROUND AND OBJECTIVES

Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living.

RESEARCH DESIGN AND METHODS

Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC. Only English articles were reviewed. Based on the Meleis' Health Transition (MHT) model, we categorized findings into: (a) transition conditions; (b) patterns of response; and (c) health services and interventions.

RESULTS

We included 204 unique studies. Age, cognitive/functional impairments, and caregiver burden were the most consistent risk factors for older persons' transitions to FBC. Caregiver burden was the only consistent risk factor in both quantitative and qualitative literature. Other factors around health service use or nonmedical factors were examined in a small number of studies, or demonstrated mixed or nonsignificant results. Key research gaps relate to transitions to intermediate levels of FBC, research in public health systems, and research employing qualitative and interventional methods.

DISCUSSION AND IMPLICATIONS

We expanded the MHT model to capture informal caregivers and their critical role in transitions from home to FBC settings. More research is needed to address practical needs of clients and caregivers while at home, and self-directed care funding models could be expanded. Theory-driven interventional research focusing on caregivers and successful hospital discharge is critically needed.

Use and Acceptance of Digital Communication Technology by Older Adults for Social Connectedness During the COVID-19 Pandemic: Mixed Methods Study

BACKGROUND

Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic.

OBJECTIVE

This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT.

METHODS

A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes.

RESULTS

Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed.

CONCLUSIONS

The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs.

Improving continence management for people with dementia in the community in Aotearoa, New Zealand: Protocol for a mixed methods study

BACKGROUND

The number of people living with dementia (PLWD) in Aotearoa New Zealand (NZ) was estimated at 96,713 in 2020 and it is anticipated that this number will increase to 167,483 by 2050, including an estimated 12,039 Māori (indigenous people of NZ) with dementia. Experiencing urinary incontinence (UI) or faecal incontinence (FI) is common for PLWD, particularly at the later stages of the disease. However, there is no robust estimate for either prevalence or incidence of UI or FI for PLWD in NZ. Although caregivers rate independent toilet use as the most important activity of daily living to be preserved, continence care for PLWD in the community is currently not systematised and there is no structured care pathway. The evidence to guide continence practice is limited, and more needs to be known about caregiving and promoting continence and managing incontinence for PLWD in the community. This project will seek to understand the extent of the challenge and current practices of health professionals, PLWD, caregivers and family; identify promising strategies; co-develop culturally appropriate guidelines and support materials to improve outcomes; and identify appropriate quality indicators so that good continence care can be measured in future interventions.

METHODS AND ANALYSIS

A four-phase mixed methods study will be delivered over three years: three phases will run concurrently, followed by a fourth transformative sequential phase. Phase 1 will identify the prevalence and incidence of incontinence for PLWD in the community using a cohort study from standardised home care interRAI assessments. Phase 2 will explore continence management for PLWD in the community through a review of clinical policies and guidance from publicly funded continence services, and qualitative focus group interviews with health professionals. Phase 3 will explore experiences, strategies, impact and consequences of promoting continence and managing incontinence for PLWD in the community through secondary data analysis of an existing carers' study, and collecting new cross-sectional and longitudinal qualitative data from Māori and non-Māori PLWD and their caregivers. In Phase 4, two adapted 3-stage Delphi processes will be used to co-produce clinical guidelines and a core outcome set, while a series of workshops will be used to co-produce caregiver resources.

In-hospital outcomes among older medical inpatients admitted to aged care wards after activation of a 2-tier rapid response system

BACKGROUND

The outcomes of rapid response systems (RRS) are poorly established in older people. We examined the outcomes in older inpatients at a tertiary hospital that uses a 2-tier RRS, including the outcomes of each tier.

METHODS

The 2-tier RRS comprised the clinical review call (CRC) (tier one) and the medical emergency team call (MET) (tier two). We compared the outcomes in four configurations of MET and CRC (MET with CRC; MET without CRC; CRC without MET; neither MET nor CRC). The primary outcome was in-hospital death, and secondary outcomes were length of stay (LOS) and new residential facility placement. Statistical analyses were carried out using Fisher's exact tests, Kruskal-Wallis tests, and logistic regression.

RESULTS

A total of 433 METs and 1,395 CRCs occurred among 3,910 consecutive admissions of mean age 84 years. The effect of a MET on death was unaffected by the occurrence of a CRC. The rates of death for MET ± CRC, and CRC without MET, were 30.5% and 18.5%, respectively. Patients having one or more MET ± CRC (adjusted odds ratio [aOR] 4.04, 95% confidence interval [CI] 2.96-5.52), and those having one or more CRC without MET (aOR 2.22, 95% CI 1.68-2.93), were more likely to die in adjusted analysis. Patients who required a MET ± CRC were more likely to be placed in a high-care residential facility (aOR 1.52, 95% CI 1.03-2.24), as were patients who required a CRC without MET (aOR 1.61, 95% CI 1.22-2.14). The LOS of patients who required a MET ± CRC, and CRC without MET, was longer than that of patients who required neither (P < 0.001).

CONCLUSIONS

Both MET and CRC were associated with increased likelihood of death and new residential facility placement, after adjusting for factors such as age, comorbidity, and frailty. These data are important for patient prognostication, discussions on goals of care, and discharge planning. The high death rate of patients requiring a CRC (without a MET) has not been previously reported, and may suggest that CRCs among older inpatients should be expediated and attended by senior medical personnel.

Changes in disability over time among older working-age adults: Which global and specific limitations are increasing in Germany using the SHARE-data from 2004 to 2015?

Objectives

Previous studies have observed increasing limitations among the middle-aged, including those aged 40-64, raising the question how healthy work participation has changed. Helping answer this question, we ask: How have general and specific limitations changed in working and non-working adults in Germany?

Methods

We used population-based data of older working-age adults, aged 50-64 years old, from Germany provided by the Survey of Health Aging and Retirement (SHARE) study from 2004 to 2014 (N = 3522). Multiple logistic regression analyses were used to study changes in limitations over time.

Results

We found that employment rates generally increased over time, whereas limitation rates mostly increased among participants aged 50-54 and mostly decreased among participants aged 60-64 in both the working and non-working population. Regarding type of disability, increases were more pronounced with movement-related and general activity-related limitations.

Conclusion

Therefore, if the comparatively younger more-limited cohorts age and replace the older less-limited cohorts, a larger part of the working and non-working life might be expected to be spent with limitations in the future, and it seems questionable whether further substantial increases in healthy work participation can be achieved. Further prevention efforts and assistance should be directed at current middle-aged cohorts to improve and maintain their health, including adapting current working conditions to a work force with more limitations.

Dietary patterns and the risk of Alzheimer's disease in an elderly Iranian population: a case-control study

BACKGROUND

An increasing number of studies in Western countries have shown that healthy eating patterns have a protective effect against cognitive decline and dementia, however, information about this relationship among non-western populations with different cultural environments is scarce. The present study investigated the association between dietary patterns (DPs) and cognitive function in the Iranian elderly.

METHODS

In this case-control study, the data of 290 elderly people in two groups of case and control (Mean age in case: 74.2 ± 8.6, in control: 67.3 ± 7.3 year) were analyzed. Two DPs of healthy and unhealthy were extracted from a 142-item dish-based food frequency questionnaire, and patterns driven by principal components analysis (PCA) of 25 food groups. Multivariate binary logistic regression calculated the odds ratio (OR) of cognitive impairment with adjustment for potential confounding factors.

RESULTS

A healthy DP, characterized by high consumption of fruits and vegetables, legumes, and nuts, was related to a decrease in the odds of Alzheimer's disease in Iranian elderly people. Also, moderate adherence to an unhealthy food pattern was associated with an increase in the probability of the disease; however, the association was not statistically significant.

CONCLUSION

In this elderly population, a healthy eating pattern was associated with reducing the risk of Alzheimer's disease. Further prospective studies are recommended.

Methods to assess the effectiveness and acceptance of information and communication technology-based assistive technology for older adults: a scoping review

An aging society is a growing challenge for families, social and rehabilitation service providers, and economies. Information and communication technology-based assistive technology can bolster the independence of older adults (65 years and above) and reduce their burden on caregivers. Currently, there is no unified methodology to assess the effectiveness and acceptance of these technologies. The present study undertakes a scoping review to (1) identify and characterize the methods for assessing the acceptability and usability of information and communication technology-based assistive technologies, (2) explore the advantages and disadvantages of the assessment methods, (3) determine the possibilities of combining the assessment methods and (4) define the most commonly used assessment method and set of outcome measures. The literature was searched in MEDLINE, Scopus, IEEE Cochrane and Web of Science bibliographic databases using the keywords defined by reviewers for articles in English published between 2011 and 2021. Of the 1696 matches, 31 met the inclusion criteria. It was found that a combination of different assessment methods was common in outcome measurements. Of the 31 studies, assessment methods were combined in 21 studies and multiple questionnaires were used in 11 studies. The most common technique of outcome measurement was the use of questionnaires (81%), conducting interviews (48%) and recording usability-performance measures (39%). The advantages and disadvantages of the assessment methods could not be determined in the selected studies in this scoping review.

Adherence of Older Cardiac Patients to a Home-Based Cardiac Rehabilitation Program

Referral to home-based cardiac rehabilitation (HBCR) is low among older and frailer patients due to low expectations regarding adherence by healthcare professionals. The aim of this study was to determine adherence to HBCR when old and frail patients are referred, and to explore any differences in baseline characteristics between adherent and nonadherent patients. Data of the Cardiac Care Bridge were used (Dutch trial register NTR6316). The study included hospitalized cardiac patients ≥ 70 years old and at high risk of functional loss. Adherence to HBCR was confirmed when two-thirds of the intended nine sessions were followed. Of the 153 patients included (age: 82 ± 6 years, 54% female), 29% could not be referred due to death before referral, not returning home, or practical problems. Of the 109 patients who were referred, 67% adhered. Characteristics associated with non-adherence were older age (84 ± 6 vs. 82 ± 6, p = 0.05) and higher handgrip strength in men (33 ± 8 vs. 25 ± 11, p = 0.01). There was no difference in comorbidity, symptoms, or physical capacity. Based on these observations, most older cardiac patients who return home after hospital admission appear to adhere to HBCR after referral, suggesting that most older cardiac patients are motivated and capable of receiving HBCR.

Classifying Polypharmacy According to Pharmacotherapeutic and Clinical Risks in Older Adults: A Latent Class Analysis in Quebec, Canada

INTRODUCTION

The simplistic definition of polypharmacy, often designated as the concomitant use of five medications or more, does not distinguish appropriate from inappropriate polypharmacy. Classifying polypharmacy according to varying levels of health risk would help optimise medication use.

OBJECTIVE

We aimed to characterise different types of polypharmacy among older adults and evaluate their association with mortality and institutionalisation.

METHODS

Using healthcare databases from the Quebec Integrated Chronic Disease Surveillance System, we selected a community-based random sample of the population ≥ 66 years old covered by the public drug plan. Categorical indicators used to describe polypharmacy included number of medications, potentially inappropriate medications (PIMs), drug-drug interactions, enhanced surveillance medications, complex route of administration medications, anticholinergic cognitive burden (ACB) score and use of blister cards. We used a latent class analysis to subdivide participants into distinct groups of polypharmacy. Their association with 3-year mortality and institutionalisation was assessed with adjusted Cox models.

RESULTS

In total, 93,516 individuals were included. A four-class model was selected with groups described as (1) no polypharmacy (46% of our sample), (2) high-medium number of medications, low risk (33%), (3) medium number of medications, PIM use with or without high ACB score (8%) and (4) hyperpolypharmacy, complex use, high risk (13%). Using the class without polypharmacy as the reference, all polypharmacy classes were associated with 3-year mortality and institutionalisation, with the most complex/inappropriate classes denoting the highest risk (hazard ratio [HR] [95% confidence interval]: class 3, 70-year-old point estimate for mortality 1.52 [1.30-1.78] and institutionalisation 1.86 [1.52-2.29]; class 4, 70-year-old point estimate for mortality 2.74 [2.44-3.08] and institutionalisation 3.11 [2.60-3.70]).

CONCLUSIONS

We distinguished three types of polypharmacy with varying pharmacotherapeutic and clinical appropriateness. Our results highlight the value of looking beyond the number of medications to assess polypharmacy.

Health trajectories of elderly living in French senior housing: a longitudinal perspective

Senior housing for older adults could be an alternative or a transitional care model between home care and nursing home care. Using two longitudinal cohorts of community dwellers aged 65 years or older, we compared risks of mortality and of nursing homes admission between older adults who did or did not move to senior housing over time. In the 3C study (n = 2104, 17 years of follow-up), 143 (6.8%) participants moved into a senior housing during the follow-up. This move was associated with a lower risk of mortality (hazard ratio (HR): 0.64; 95% confidence interval (CI) 0.46-0.77) and a higher risk of nursing home admissions (HR: 1.54 (1.10-2.15)). The risks of hospitalizations (HR: 0.54 (0.40-0.73)) and falls (HR: 0.63 (0.50-0.79)) were lower. In the PAQUID study (n = 3777, 27 years of follow-up), 161 (4.3%) participants moved into a senior housing. This move was also associated with a lower mortality risk (HR: 0.72 (0.58-0.88)) and a higher risk of nursing home admissions (HR: 1.39 (1.05-1.86)). Our results showing lower risks of mortality suggest that senior housing may be a relevant model for vulnerable older adults.

Perfil e indicadores de los establecimientos de larga estadía para adulto mayor en Chile

BACKGROUND AND OBJECTIVE

In this article we sought to characterize the Long Stay Establishments for the Elderly in Chile, besides presenting the services offered in the public and private.

MATERIAL AND METHODS

It is a quantitative, cross-sectional descriptive study, with secondary information source. We analyze all establishments in the country registered with the National Service of the Elderly. As of November 2015, a total of 724 establishments were registered and distributed in 169 neighborhoods throughout the country in which 16,985 adults aged 60 and over were institutionalized.

RESULTS

Most of the establishments (65.9% [n=246/724]) are private, 47.5% of them (n=344/724) are located in the metropolitan region of Santiago. Of the residents' health, only 26.5% are considered functional brave, 28.3% are physically handicapped and 8.8% are mentally handicapped. Most establishments offer manual activities, physical exercises, memory classes, cultural classes and recreational or touristic tours. Proportionally of the activities offered were mostly private ones.

CONCLUSIONS

In Chile, most of the establishments are private, located in the metropolitan region where there is the largest supply deficit of this type of service, with an occupancy rate of 90.7%, with 72.4% women and almost half 47.7% with some physical or psychic dependence.

A national profile of sandwich generation caregivers providing care to both older adults and children

BACKGROUND

Many U.S. caregivers provide care to the generation above and below simultaneously, described as "sandwich" generation caregivers. We seek to provide the first national estimates characterizing sandwich generation caregivers and the older adults for whom they care.

METHODS

We used the 2015 National Study of Caregiving (NSOC) and National Health and Aging Trends Study (NHATS) to compare individual (demographic, socio-economic, health, and caregiving characteristics) and caregiving-related experience (financial and emotional difficulties, caregiver role overload and gains, supportive services, employment and participation restrictions) between sandwich and non-sandwich generation caregivers. The analysis included adult child caregivers with or without any minor child under 18 years (n = 194 and 912 NSOC respondents, respectively) providing care to n = 436 and 1217 older adult NHATS respondents.

RESULTS

Of all adult child caregivers, 24.3% also cared for a minor child (i.e., sandwich generation caregivers), representing 2.5 million individuals. Sandwich generation caregivers provided similar care hours to older care recipients as non-sandwich caregivers (77.4 vs. 71.6 h a month, p = 0.60), though more of them worked for pay (69.4% vs. 53.9%, p = 0.002). Both sandwich generation caregivers (21.0% vs. 11.1%, p = 0.005) and their care recipients (30.1% vs. 20.9%, p = 0.006) were more likely to be Medicaid enrollees than their non-sandwich caregiving counterparts. More sandwich generation caregivers reported substantial financial (23.5% vs. 12.2%, p < 0.001) and emotional difficulties (44.1% vs. 32.2%, p = 0.02) than non-sandwich caregivers; they also reported higher caregiver role overload (score: 2.9 vs. 2.4, p = 0.04). Their supportive services use was similarly low as non-sandwich caregivers except for seeking financial help (24.8% vs. 14.7%, p = 0.008).

CONCLUSIONS

Besides caring for minor child(ren), sandwich generation caregivers provided similarly intense care to care recipients as non-sandwich caregivers and had higher labor force participation; they experienced more caregiving-related financial and emotional difficulties and role overload. Policymakers may consider supportive services that address their unique needs and roles.

COVID-19 in older adult residents in nursing homes: factors associated with mortality and impact on functional capacity

Objective

To verify if the functional capacity prior to COVID-19 infection was different between Survivor and Non-survivor older adults. Also, to verify the effect of the isolation period after COVID-19 infection on the functional capacity of the Survivors residing in nursing homes.

Materials and methods

Older adults residing in nursing homes were evaluated 30 days before the COVID-19 outbreak at the site for (i) general health characteristics (obtained from medical records); (ii) gait speed, handgrip strength and 30-s sit-to-stand; (iii) sarcopenia and (iv) estimated muscle mass. Comparisons were made between Survivors and Non-survivors of COVID-19. After the isolation, the Survivors performed the assessments again.

Results

Twenty-one (81 ± 9.3 years) participants tested positive for COVID-19 and participated in the study, 12 survivors. No difference was observed between Survivors and Non-survivors in any of the outcomes evaluated. However, a moderate effect size was observed for handgrip strength, with lower values for the Non-survivors group (- 16%; d = 0.53). The isolation period reduced the number of sit-to-stand repetitions with moderate effect size in the Survivors (p = 0.046, gav = 0.66).

Conclusion

Although the null hypothesis analysis did not find significant differences between the groups, the effect size suggests that older adults residing in nursing homes who died from COVID-19 had lower handgrip strength. In the survivors, the isolation period after COVID-19 infection only negatively impacted the sit-to-stand performance.

Trends in Nursing Home Complaints: Prevalence and Variation Across Center for Medicare and Medicaid Services Regions

Resident complaints are vital to understanding nursing home (NH) quality. Using complaints as facility- and resident-level outcomes, this study replicates prior analyses (spanning 1998-2002 and 2007-2012) with 2013-2017 data, the phase prior to NH regulatory changes initiated in November, 2017. Advancing prior papers, we analyze the number of complaints, allegations, and deficiency citations separately. Between 2013-2017, 458,101 total complaints (5.9/NH/year) were identified, containing 949,466 allegations (12.2/NH/year), and resulting in the issuance of 156,135 deficiency citations (2.0/NH/year) in about 15,600 NHs across the country. Regarding the number of complaints, substantiated complaints, and deficiency citations, results show a steady increase compared to previous years. Furthermore, there are marked differences among the CMS survey regions on the prevalence of overall complaints, substantiated complaints, and deficiency citations. However, the average rate of substantiation of complaint allegations shows a decreasing trend over these years, suggesting that complaints may have increased due to higher care expectations.

Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans

OBJECTIVES

To evaluate the associations between specific functional needs of older Veterans and the desire to institutionalize (DTI) among their caregivers.

METHODS

Cross-sectional multivariable logistic regression analysis of 3579 Hero Care survey responses from caregivers of Veterans at five US sites from July to December 2021. Unmet needs were areas in which the caregiver reported the Veteran needed a little more or a lot more help. Caregiver DTI was defined as the caregiver reporting that they had discussed, considered, or taken steps toward a nursing home or assisted living placement for the Veteran or that they felt the Veteran would be better off in such a setting or they were likely to move the Veteran to another living arrangement.

RESULTS

Caregivers were largely white, retired, females with an average age of 71 and with some college education who spent an average of 8-9 h per day 6 days a week caring for a Veteran spouse. There was evidence of associations between the following needs and a DTI: managing incontinence, using the telephone, transportation, and arranging services in the home such as visiting nurses, home care aides, or meals on wheels. Unmet functional needs in other selected domains were not associated with the DTI.

CONCLUSION

Among caregivers of older Veterans, a need for more assistance managing incontinence, telephone use, transportation, and arranging in-home services were associated with the DTI. These may represent functional markers of important clinical determinants for institutionalization as well as potential targets for intervention to reduce caregiver DTI, such as programs that provide more caregiver or Veteran support in the home to meet these needs and reduce caregiver burden.

A novel easy-to-use index to predict institutionalization and death in older population - a 10-year population-based follow-up study

BACKGROUND

Various indexes have been developed to estimate the risk for mortality, institutionalization, and other adverse outcomes for older people. Most indexes are based on a large number of clinical or laboratory parameters. An index based on only a few parameters would be more practical to use in every-day clinical practice. Our aim was to create an index to predict the risk for mortality and institutionalization with as few parameters as possible without compromising their predictive ability.

METHODS

A prospective study with a 10-year follow-up period. Thirty-six clinical and fourteen laboratory parameters were combined to form an index. Cox regression model was used to analyze the association of the index with institutionalization and mortality. A backward statistical method was used to reduce the number of parameters to form an easy-to-use index for predicting institutionalization and mortality.

RESULTS

The mean age of the participants (n = 1172) was 73.1 (SD 6.6, range 64‒97) years. Altogether, 149 (14%) subjects were institutionalized, and 413 (35%) subjects deceased during the follow-up. Institutionalization and mortality rates increased as index scores increased both for the large 50-parameter combined index and for the reduced indexes. After a backward variable selection in the Cox regression model, three clinical parameters remained in the index to predict institutionalization and six clinical and three laboratory parameters in the index to predict mortality. The reduced indexes showed a slightly better predictive value for both institutionalization and mortality compared to the full index.

CONCLUSIONS

A large index with fifty parameters included many unimportant parameters that did not increase its predictive value, and therefore could be replaced with a reduced index with only a few carefully chosen parameters, that were individually associated with institutionalization or death.