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A Mixed-Methods Analysis of Care Arrangements of Older People with Limited Physical Abilities Living Alone in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412996. [PMID: 34948603 PMCID: PMC8700972 DOI: 10.3390/ijerph182412996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/25/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
Older people with limited physical abilities, who live alone without cohabiting family members, need support ageing in place and to perform daily living activities. In this respect, both the available informal and formal care seem crucial. The present study aimed to explore the current role of the care arrangements of older people, especially if they have functional limitations. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 older people who lived at home, alone, or with a private personal care assistant (PCA) in three Italian regions (Lombardy, Marche, and Calabria). A mixed-methods analysis was conducted. Results showed that support networks are still mainly made up of family members, but also of domestic home help (DHH) and PCAs, friends/neighbours, and public services, albeit the latter provide support in a residual way, while the former is not as intensive as it was in the past. Frequency and geographical/living proximity of help play a role, emerging also as a territorial differentiation. The paucity or absence of support, especially from the family, risks compromising the ability of ageing in place. It seems, thus, necessary to innovate and improve, in particular, home services, also through real formal and informal care integration.
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2
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Solé-Auró A, Deeg DJH. New thinking about health expectancy: introduction to the special section. Eur J Ageing 2021; 18:439-441. [PMID: 34790083 PMCID: PMC8563872 DOI: 10.1007/s10433-021-00630-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Aïda Solé-Auró
- DemoSoc Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, C/Ramon Trias Fargas, 25-27, 08005 Barcelona, Spain
| | - Dorly J. H. Deeg
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Gender differences in years of remaining life by living arrangement among older Singaporeans. Eur J Ageing 2021; 18:453-466. [PMID: 34790084 DOI: 10.1007/s10433-020-00594-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022] Open
Abstract
Living arrangements of older adults have often been studied as a measure of the support available to them. Given the rapidly ageing and low fertility context of Singapore where the prevalence of older adults living alone and without children is expected to increase, we construct multistate life tables to estimate the number of years that older persons can expect to live in different living arrangements at a population level (population-based) as well as based on their initial living arrangement (status-based). We focus particularly on whether there are gender differences in the expected years of life in different living arrangement states. We use the Panel on Health and Ageing of Singaporean Elderly, a 2009 nationally representative survey of 4990 Singaporeans aged 60 years and older, with follow-up surveys in 2011 and 2015. In calculating the probabilities of transition between different states, we control for number of children, housing type, and time-varying ADL limitations. We find that at age 60, women can expect to spend more than twice the proportion (18%) of their remaining lives living alone compared to men (7%). Status-based estimates indicate that the proportion of remaining years living with a child is higher for women initially living alone, with a spouse only or already with a child, compared to males. Our results indicate that while older women are more likely to live alone compared to their male counterparts, older women living alone are also more likely to transition to living with children. Our research sheds light on the importance of expanding research on life expectancy beyond health, to consider analysis using other forms of social stratification, particularly gender differences in states of living arrangement. Supplementary Information The online version of this article contains supplementary material available at 10.1007/s10433-020-00594-3.
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Barrenetxea J, Tan KB, Tong R, Chua K, Feng Q, Koh WP, Chen C. Emergency hospital admissions among older adults living alone in the community. BMC Health Serv Res 2021; 21:1192. [PMID: 34732180 PMCID: PMC8567640 DOI: 10.1186/s12913-021-07216-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity. Methods We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity. Results Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity. Conclusions Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.
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Affiliation(s)
- Jon Barrenetxea
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore
| | | | - Kevin Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, SG, Singapore, Singapore
| | - Qiushi Feng
- Department of Sociology & Centre for Family and Population Research, National University of Singapore, Singapore, Singapore
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore. .,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, 117545, Singapore, Singapore. .,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore.
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
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Meyre PB, Springer A, Aeschbacher S, Blum S, Rodondi N, Beer JH, Di Valentino M, Ammann P, Blum M, Mathys R, Meyer-Zürn C, Bonati LH, Sticherling C, Schwenkglenks M, Kühne M, Conen D, Osswald S. Association of psychosocial factors with all-cause hospitalizations in patients with atrial fibrillation. Clin Cardiol 2020; 44:51-57. [PMID: 33169859 PMCID: PMC7803348 DOI: 10.1002/clc.23503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/21/2020] [Indexed: 01/28/2023] Open
Abstract
Background A high burden of cardiovascular comorbidities puts patients with atrial fibrillation (AF) at high risk for hospitalizations, but the role of other factors is less clear. Hypothesis To determine the relationship between psychosocial factors and the risk of unplanned hospitalizations in AF patients. Methods Prospective observational cohort study of 2378 patients aged 65 or older with previously diagnosed AF across 14 centers in Switzerland. Marital status and education level were defined as social factors, depression and health perception were psychological components. The pre‐defined outcome was unplanned all‐cause hospitalization. Results During a median follow‐up of 2.0 years, a total of 1713 hospitalizations occurred in 37% of patients. Compared to patients who were married, adjusted rate ratios (aRR) for all‐cause hospitalizations were 1.28 (95% confidence interval [CI], 0.97‐1.69) for singles, 1.31 (95%CI, 1.06‐1.62) for divorced patients, and 1.02 (95%CI, 0.82‐1.25) for widowed patients. The aRRs for all‐cause hospitalizations across increasing quartiles of health perception were 1.0 (highest health perception), 1.15 (95%CI, 0.84‐1.59), 1.25 (95%CI, 1.03‐1.53), and 1.66 (95%CI, 1.34‐2.07). No different hospitalization rates were observed in patients with a secondary or primary or less education as compared to patients with a college degree (aRR, 1.06; 95%CI, 0.91‐1.23 and 1.05; 95%CI, 0.83‐1.33, respectively). Presence of depression was not associated with higher hospitalization rates (aRR, 0.94; 95%CI, 0.68‐1.29). Conclusions The findings suggest that psychosocial factors, including marital status and health perception, are strongly associated with the occurrence of hospitalizations in AF patients. Targeted psychosocial support interventions may help to avoid unnecessary hospitalizations. Trial registration ClinicalTrials.gov Identifier NCT02105844.
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Affiliation(s)
- Pascal B Meyre
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Anne Springer
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Steffen Blum
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juerg H Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland
| | - Marcello Di Valentino
- Department of Cardiology, Ospedale San Giovanni, Bellinzona, Switzerland.,Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | | | - Manuel Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rebecca Mathys
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Christine Meyer-Zürn
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Michael Kühne
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stefan Osswald
- Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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Andersen HE, Hoeck B, Nielsen DS, Ryg J, Delmar C. A phenomenological-hermeneutic study exploring caring responsibility for a chronically ill, older parent with frailty. Nurs Open 2020; 7:951-960. [PMID: 32587713 PMCID: PMC7308672 DOI: 10.1002/nop2.467] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/17/2019] [Accepted: 02/16/2020] [Indexed: 11/07/2022] Open
Abstract
Aim To provide lifeworld insights into experiences of adult children with caring responsibility for an 80+-year-old chronically ill parent with frailty. Background Informal care is common in Nordic welfare countries; however, little is known about adult children's experience of caring responsibility in this setting. Design A phenomenological-hermeneutic study based on Reflective Lifeworld Research. Methods Diaries and semi-structured interviews with 12 adult children. Results Caring responsibility is identified as "a condition of life, filled with uncertainty." Three constituents contribute to this phenomenon: (a) balancing love, duty and reciprocity; (b) being the parent's advocate and manager; and (c) experiencing concerns and bodily strain. Conclusion Adult children work hard to provide care and enhance the well-being of their parent. Heidegger's concept 'Fürsorge' may help us understand how by showing how caring responsibility means balancing different roles vis-à-vis the parent, one's own life and the health and social systems. Caring responsibility changes the relationship between parent and child.
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Affiliation(s)
- Helle Elisabeth Andersen
- Department of Public Health NursingAarhus UniversityAarhusDenmark
- Health Sciences Research CentreUCLOdenseDenmark
| | - Bente Hoeck
- Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Dorthe Susanne Nielsen
- Health Sciences Research CentreUCLOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Migrant Health ClinicOdense University HospitalOdenseDenmark
| | - Jesper Ryg
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Department of Geriatric MedicineOdense University HospitalOdenseDenmark
| | - Charlotte Delmar
- Department of Public Health NursingAarhus UniversityAarhusDenmark
- Institut for Helse‐ og omsorgsfagNorway's Artic UniversityTromsøNorway
- VIDHelsefagBergenOsloNorway
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Unplanned Readmission within 28 Days of Hospital Discharge in a Longitudinal Population-Based Cohort of Older Australian Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093136. [PMID: 32365917 PMCID: PMC7246843 DOI: 10.3390/ijerph17093136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/28/2022]
Abstract
This study aimed to estimate the incidence of 28-day unplanned readmission among older women, and associated factors. Data were used from the 1921–1926 birth cohort of the Australian Longitudinal Study on Women’s Health. Linkage of self-reported survey data with the Admitted Patient Data Collection allowed the identification of hospital admissions for each woman and the corresponding baseline characteristics. The Cox proportional-hazards model was used to identify factors associated with time to unplanned readmission, using SAS software V 9.4. (SAS Institute, Cary, NC, USA). Of 2056 women with index unplanned admission, 363 (17.5%) were readmitted within 28 days of discharge, and of these 229 (11.14%) had unplanned readmission. Among women with unplanned readmission, 24% were for the same condition as for the index hospitalisation. Cardiovascular diseases were the main diagnoses for the index admission and readmission. Unplanned readmission risk was higher if not partnered (hazard ratio (HR) = 1.43, 95% confidence interval (CI): 1.05–1.95), of non-English speaking background (HR = 1.62%, 95% CI: 1.07–2.47), more than three days length of stay on index admission (HR = 1.41%, 95% CI: 1.04–1.90) and one or two of the assessed chronic diseases (HR = 1.68, 95% CI: 1.19–2.36). At least one in ten women had unplanned readmission at some time between ages 75–95 years. Women who are not partnered, not of English-speaking background, with longer hospital stay and those with multi-morbidity, may need further efforts during their stay and on discharge to mitigate unplanned readmission.
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Cella A, Ferrari A, Rengo G, Solfrizzi V, Veronese N, Puntoni M, Zora S, Pilotto A, Fimognari F. Agreement of a Short Form of the Self-Administered Multidimensional Prognostic Index (SELFY-MPI-SF): A Useful Tool for the Self-Assessment of Frailty in Community-Dwelling Older People. Clin Interv Aging 2020; 15:493-499. [PMID: 32280206 PMCID: PMC7125337 DOI: 10.2147/cia.s241721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background The Multidimensional Prognostic Index (MPI) is a comprehensive geriatric assessment (CGA)-based tool that has shown excellent accuracy in predicting negative health outcomes in older people. Recently, the self-administered version of MPI (SELFY-MPI) has been validated in a community-dwelling sample, revealing excellent agreement with the original MPI. In the SELFY-MPI, Gijon’s social-familial evaluation scale (SFES) was used to assess socio-relational and economic aspects. Completion of the SELFY-MPI, however, requires a significant amount of time in people aged over 60 years, particularly to fill in the SFES scale. The aim of this study was to validate, in a sample of community-dwelling older people, a short-form version of the SELFY-MPI (SELFY-MPI-SF), in which the SFES scale was replaced by the “co-habitation status” domain, as in the original version of the MPI. Methods All participants included in the study completed both versions of the self-administered MPI, which share the following seven domains: 1) basic and 2) instrumental activities of daily living, 3) mobility, 4) cognition, 5) nutrition, 6) comorbidity, and 7) number of medications. Moreover, in the SELFY-MPI-SF, the 8th domain “co-habitation status” (ie living alone, with family or in a residential facility) replaced the SFES scale. The Bland–Altman methodology was applied in order to measure the agreement between the two instruments. Finally, the time to complete the SFES scale and the question on co-habitation was measured. Results The final study sample was composed of 129 participants (mean age=76.8 years, range=65–93 years, 64.3% women) were enrolled. The mean SELFY-MPI and SELFY-MPI-SF values were 0.221±0.196 and 0.246± 0.188, respectively. The mean difference was clinically irrelevant (−0.025±0.058). None of the 129 observations showed values outside the established 5% limits of agreement. The agreement between SELFY-MPI and SELFY-MPI-SF was excellent (k=0.762; rho=0.924, p<0.0001 for both). Stratified analyses of agreement among subgroups of participants of different ages did not show any significant differences between the two versions. Completion of the SFES required about 7 mins, on average, while the question on habitation status required about 10 s. Conclusion The SELFY-MPI-SF showed strong agreement and precision when compared with the standard SELFY-MPI in people aged 65 and older and can therefore be successfully used as a quicker self-administered frailty instrument in community-dwelling older people.
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Affiliation(s)
- Alberto Cella
- Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Alberto Ferrari
- Geriatric Unit, Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Division of Geriatrics, Federico II University, Napoli, Italy
| | - Vincenzo Solfrizzi
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Nicola Veronese
- Primary Care Department, Azienda ULSS 3 Serenissima, Venice, Italy
| | - Matteo Puntoni
- Scientific Coordination Unit, EO Galliera Hospital, Genova, Italy
| | - Sabrina Zora
- Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Alberto Pilotto
- Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy.,Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Filippo Fimognari
- Geriatric Unit, Department of Internal Medicine, Azienda Ospedaliera di Cosenza, Cosenza, Italy
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Parekh N, Ali K, Davies JG, Stevenson JM, Banya W, Nyangoma S, Schiff R, van der Cammen T, Harchowal J, Rajkumar C. Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool. BMJ Qual Saf 2020; 29:142-153. [PMID: 31527053 PMCID: PMC7045783 DOI: 10.1136/bmjqs-2019-009587] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To develop and validate a tool to predict the risk of an older adult experiencing medication-related harm (MRH) requiring healthcare use following hospital discharge. DESIGN, SETTING, PARTICIPANTS Multicentre, prospective cohort study recruiting older adults (≥65 years) discharged from five UK teaching hospitals between 2013 and 2015. PRIMARY OUTCOME MEASURE Participants were followed up for 8 weeks in the community by senior pharmacists to identify MRH (adverse drug reactions, harm from non-adherence, harm from medication error). Three data sources provided MRH and healthcare use information: hospital readmissions, primary care use, participant telephone interview. Candidate variables for prognostic modelling were selected using two systematic reviews, the views of patients with MRH and an expert panel of clinicians. Multivariable logistic regression with backward elimination, based on the Akaike Information Criterion, was used to develop the PRIME tool. The tool was internally validated. RESULTS 1116 out of 1280 recruited participants completed follow-up (87%). Uncertain MRH cases ('possible' and 'probable') were excluded, leaving a tool derivation cohort of 818. 119 (15%) participants experienced 'definite' MRH requiring healthcare use and 699 participants did not. Modelling resulted in a prediction tool with eight variables measured at hospital discharge: age, gender, antiplatelet drug, sodium level, antidiabetic drug, past adverse drug reaction, number of medicines, living alone. The tool's discrimination C-statistic was 0.69 (0.66 after validation) and showed good calibration. Decision curve analysis demonstrated the potential value of the tool to guide clinical decision making compared with alternative approaches. CONCLUSIONS The PRIME tool could be used to identify older patients at high risk of MRH requiring healthcare use following hospital discharge. Prior to clinical use we recommend the tool's evaluation in other settings.
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Affiliation(s)
- Nikesh Parekh
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Khalid Ali
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Winston Banya
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | - Tischa van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Chakravarthi Rajkumar
- Academic Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK
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10
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Deardorff WJ, Liu PL, Sloane R, Van Houtven C, Pieper CF, Hastings SN, Cohen HJ, Whitson HE. Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults. J Am Geriatr Soc 2019; 67:1617-1624. [PMID: 30924932 PMCID: PMC6684393 DOI: 10.1111/jgs.15891] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine the association between self-reported vision impairment (VI), hearing impairment (HI), and dual-sensory impairment (DSI), stratified by dementia status, on hospital admissions, hospice use, and healthcare costs. DESIGN Retrospective analysis. SETTING Medicare Current Beneficiary Survey from 1999 to 2006. PARTICIPANTS Rotating panel of community-dwelling Medicare beneficiaries, aged 65 years and older (N = 24 009). MEASUREMENTS VI and HI were ascertained by self-report. Dementia status was determined by self-report or diagnosis codes in claims data. Primary outcomes included any inpatient admission over a 2-year period, hospice use over a 2-year period, annual Medicare fee-for-service costs, and total healthcare costs (which included information from Medicare claims data and other self-reported payments). RESULTS Self-reported DSI was present in 30.2% (n = 263/871) of participants with dementia and 17.8% (n = 4112/23 138) of participants without dementia. In multivariable logistic regression models, HI, VI, or DSI was generally associated with increased odds of hospitalization and hospice use regardless of dementia status. In a generalized linear model adjusted for demographics, annual total healthcare costs were greater for those with DSI and dementia compared to those with DSI without dementia ($28 875 vs $3340, respectively). Presence of any sensory impairment was generally associated with higher healthcare costs. In a model adjusted for demographics, Medicaid status, and chronic medical conditions, DSI compared with no sensory impairment was associated with a small, but statistically significant, difference in total healthcare spending in those without dementia ($1151 vs $1056; P < .001) but not in those with dementia ($11 303 vs $10 466; P = .395). CONCLUSION Older adults with sensory and cognitive impairments constitute a particularly prevalent and vulnerable population who are at increased risk of hospitalization and contribute to higher healthcare spending. J Am Geriatr Soc 67:1617-1624, 2019.
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Affiliation(s)
| | - Phillip L. Liu
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Richard Sloane
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Courtney Van Houtven
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Carl F. Pieper
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Susan Nicole Hastings
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, NC
| | - Harvey J. Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Heather E. Whitson
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, NC
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC
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11
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Dahlberg L, Agahi N, Schön P, Lennartsson C. Planned and Unplanned Hospital Admissions and Their Relationship with Social Factors: Findings from a National, Prospective Study of People Aged 76 Years or Older. Health Serv Res 2018; 53:4248-4267. [PMID: 29952093 PMCID: PMC6232498 DOI: 10.1111/1475-6773.13001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationship between social factors and planned and unplanned hospital admissions among older people. DATA SOURCES/STUDY SETTING 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. STUDY DESIGN The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors). DATA COLLECTION Data were collected via interviews with people aged 76+ (n = 931). PRINCIPAL FINDINGS Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09-0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15-2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13-2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis. CONCLUSIONS Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.
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Affiliation(s)
- Lena Dahlberg
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Carin Lennartsson
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
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