The Association Between Activity Limitation Stages and Admission to Facilities Providing Long-term Care Among Older Medicare Beneficiaries

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.

Reliability and Validity of the Minimum Data Set 3.0 Standardized Self-Care and Mobility Data Elements Among Long-Stay Nursing Home Residents

PURPOSE

To assess the reliability and validity of a subset of the Minimum Data Set (MDS) 3.0 Section GG data elements (i.e., standardized self-care, mobility) among 147 long-stay nursing home residents in seven nursing homes in five states.

METHOD

Trained clinicians assessed residents' functional abilities using select Section GG items and Section G activities of daily living items. We examined the reliability and construct validity of the data using Cronbach's alpha, correlations between Section G and Section GG items, confirmatory factor analysis (CFA), and Rasch measurement analysis.

RESULTS

We observed acceptable internal consistency values for all (0.98), self-care (0.93), and mobility (0.98) standardized items. Correlations between conceptually related Section G and Section GG items ranged from -0.53 to -0.84. CFA findings found acceptable values for all fit indices. Rasch analysis showed most items had acceptable fit statistics, except for the easiest and most difficult activities.

CONCLUSION

These findings establish the feasibility of data collection, internal consistency reliability, and construct validity of the selected Section GG items among long-stay nursing home residents. Use of the same standardized data elements in post-acute and long-term care populations can support improved coding of function and enhance our understanding of resident functioning. [Research in Gerontological Nursing, 17(2), 57-64.].

Admission to the Long-Term Care Facilities and Institutionalization Rate in Community-Dwelling Frail Adults: An Observational Longitudinal Cohort Study

The worldwide aging and the increase of chronic disease impacted the Health System by generating an increased risk of admission to Long-Term Care (LTC) facilities for older adults. The study aimed to evaluate the admission rate to LTC facilities for community-dwelling older adults and investigate factors associated with these admissions. A secondary data analysis stemming from an observational longitudinal cohort study (from 2014 to 2017) was performed. The sample was made up by 1246 older adults (664 females and 582 males, mean age 76.3, SD ± 7.1). The LTC facilities access rate was 12.5 per 1000 observations/ year. Multivariable Linear Regression identified frailty, cardiovascular disease, and incapacity to take medicine and manage money as predictors of the LTC facilities’ access rate. The Multiple Correspondence Analysis identified three clusters: those living at home with comorbidities; those living in LTC facilities who are pre-frail or frail; those very frail but not linked to residential LTC. The results indicate that access to LTC facilities is not determined by severe disability, severe comorbidity, and higher frailty levels. Instead, it is related to moderate disability associated with a lack of social support. Therefore, the care policies need to enhance social interventions to integrate medical, nursing, and rehabilitative care.

Misuse of Prescription Medications among Individuals with Mobility Disability

BACKGROUND

The ability of walking a quarter mile is predictive of subsequent disability, mortality, and health care costs. Individuals with mobility disability are at increased risk of chronic conditions and unmet care needs. Thus they may misuse prescription medications to self-medicate.

OBJECTIVES

We aimed to explore the difference of misuse of four types of prescription medications (sedatives, tranquilizers, painkillers, depression medications) and overall misuse by mobility status and identify the correlates of overall misuse.

METHODS

A national probability sample from the survey Midlife in the United States (MIDUS) was used to assess the difference in misuse by mobility status during 2011-2014. To assess the correlates of misuse, mobility status, usual source of care, unmet care needs, insurance coverage, sociodemographic variables, and clinical conditions were added to a survey weighted logistic regression model with backward selection.

RESULTS

Compared to those without mobility disability, individuals with mobility disability had higher risk of misuse in most types of medications and in overall misuse. Mobility disability, lower education, unmarried status, the emergency room or public health clinic as the most often used care, pain, and depressed affect were identified as correlates of overall misuse of studied medications.

CONCLUSIONS

Individuals with mobility disability are a vulnerable group susceptible to medication misuse, which warrants the urgent need for interventions to ameliorate misuse and reduce risks in this population.

Psychological and behavioral responses during the COVID-19 pandemic among individuals with mobility and/or self-care disabilities

Background

The lockdowns during the COVID-19 pandemic created major obstacles for individuals with disabilities to obtain support in their daily living.

Objectives

This study was to examine the psychological and behavioral responses of US individuals with mobility and/or self-care disabilities during the pandemic.

Methods

From a nationally representative longitudinal survey (n = 6403) administered during the pandemic, individuals were classified at baseline as having no mobility/self-care disability (ADL = 0, n = 4975), mobility or self-care disability (ADL = 1, n = 1061), and both mobility and self-care disabilities (ADL = 2, n = 367). Weighted mean of baseline mental distress scores (PHQ4), psychological risk factors (loneliness, stress, perceived COVID risk), resilience, and coping were compared among these groups. Random effects models were employed to assess the effects of disability and disability-moderated effects of risk factors on mental distress.

Results

At baseline, mental distress increased with greater ADL disabilities (Mean[95%CI] = 1.88[1.77, 1.98], 2.54[2.29, 2.79], and 3.55[3.01, 4.08] for ADL = 0, 1, and 2, respectively, p < .0001). Loneliness, stress, and perceived risk increased with ADL disabilities, but resilience and social coping decreased with it (p's < 0.0001). In the random-effects models, greater ADL disabilities, higher psychological risks, and use of cannabis and other recreational drugs were associated with greater mental distress. Greater ADL disabilities augmented the detrimental effects of risk factors on mental health, but resilience protected mental health both independently and through a buffering effect on its risk factors across all groups.

Conclusion

Individuals with mobility and/or self-care disability tend to have poorer mental health and are differentially more affected by its risk factors. Mental health professionals should address these modifiable factors in interventions.

Admission to long-stay residential care and mortality among people with and without dementia living at home but on the boundary of residential care: a competing risks survival analysis

BACKGROUND

Health policy in many countries is underpinned by a commitment to support dependent older people to remain in their own home for as long as possible and practicable. This study explores factors affecting both admission to long-stay residential care (LSRC) and mortality among people with and without dementia who are currently living at home with intensive formal care support.

METHODS

This is a cross-sectional study based on administrative data collected on 429 dependent older people in Ireland, 269 of whom were people with dementia. A cause-specific hazard model was used to investigate the hazard of admission to LSRC, while accounting for mortality as a competing risk and vice versa.

RESULTS

Admission to LSRC was higher for people with dementia relative to people without and for those receiving lower amounts of informal care. The hazard of mortality was significantly higher for older people aged 85+, whereas it was lower for individuals with a medium level of dependency relative to those with high levels of dependency. The hazard of mortality was also influenced by the amount of informal care provision.

CONCLUSION

People with dementia are more likely to be admitted to LSRC than people without. Care for people with dementia needs to be more specialised and personal, and intensity of provision should not be equated to the number of care hours on offer. Informal care provision may help to prevent admission to LSRC. Advanced age, physical dependency and informal care provision affect mortality, raising interesting issues in relation to resource allocation.

Disparities in mental health, social support and coping among individuals with mobility impairment

BACKGROUND

CDC estimated that 19.4 million (7.8%) US adults are living with mobility impairment, who are unable to walk a quarter mile. Individuals with physical disability reported greater depression and, in some cases, insufficient social support.

OBJECTIVES

This study explores the extent of disparities in psychological health, social support, and coping mechanisms among those with mobility impairment as compared to those without such impairment, and the longitudinal effect of onset of mobility impairment on subsequent psychosocial health and coping.

METHODS

Individuals with mobility impairment were matched to controls from a nationally representative sample, using the propensity score method. The final sample included 345 matched pairs. Regression models with robust standard errors were used to assess disparities in outcomes by mobility status. Autoregressive models were used to assess the longitudinal effect of the onset of mobility limitation on these outcomes.

RESULTS

Those with impaired mobility fared significantly higher on negative affect (p < .05) and pessimism (p < .05), and significantly lower on life satisfaction (p < .05) and positive affect (p = .001). In terms of coping, they showed disparities in health locus of control (self) (p < .05), planning (p < .05), active coping (p < .05), and problem-focused coping (p < .05), as compared to those without mobility limitation. The onset of mobility impairment had significant effects in similar psychological and coping domains.

CONCLUSION

Our work revealed a piece of reality of individuals living with mobility impairment and will inform designing effective interventions to mitigate psychosocial health disparities in this population.

Biometric indicators can be early signs of declines in activities of daily living functioning among the Indonesian elderly

BACKGROUND

Signs associated with the onset of disability can be useful in disability projection and have significant implications in elderly care policy.

OBJECTIVE

To explored the associations between biometric screening indicators and declines in activities of daily life (ADLs) functioning among the Indonesian elderly.

METHODS

This is a prospective longitudinal cohort study. The Indonesian Family Life Survey (IFLS) 4 conducted in 2007-2008, and IFLS 5 conducted in 2014-2015 were used to assess the association between biometric indicators and ADLs at baseline and follow-up.

RESULTS

Findings revealed that 22.3% of participants surveyed in 2007-2014 had become disabled in terms of ADLs. Anemia status, stage 2 hypertension, lung capacity, and a longer sit-to-stand time were associated with ADLs.

CONCLUSION

These findings are important to help early detection and potentially help the prevention of ADLs in elderly people in the future. Accuracy of disability estimation could possibly be improved if including biometric parameters.

Premorbid Activity Limitation Stages Are Associated With Posthospitalization Discharge Disposition

OBJECTIVE

Activity of daily living stages and instrumental activity of daily living stage have demonstrated associations with mortality and health service use among older adults. This cohort study aims to assess the associations of premorbid activity limitation stages with acute hospital discharge disposition among community-dwelling older adults.

DESIGN

Study participants were Medicare beneficiaries aged 65 yrs or older who enrolled in the Medicare Current Beneficiary Survey between 2001 and 2009. Associations of premorbid stages with discharge dispositions were estimated with multinomial logistic regression models adjusted for covariates.

RESULTS

The proportions of elderly Medicare patients discharged to home with self-care, home with services, postacute care facilities, and other dispositions were 59%, 15%, 19%, and 7%, respectively. The following adjusted relative risk ratios and 95% confidence intervals of postacute care facilities versus home with self-care discharge increased with higher premorbid activity limitation stages (except nonfitting stage III): 1.7 (1.5-2.0), 2.4 (2.0-2.9), 2.4 (1.9-3.0), and 2.5 (1.6-4.1) for activity of daily living stages I-IV; a similar pattern was found for instrumental activity of daily living stages. The adjusted relative risk ratios of discharge to home with services also increased with higher premorbid activity limitation stages compared with no limitation.

CONCLUSIONS

Routinely assessed activity limitation stages predict posthospitalization discharge disposition among older adults and may be used to anticipate postacute care and services use by elderly Medicare beneficiaries.

Octogenarians with Multiple Sclerosis: Lessons for Aging in Place

Les facteurs de protection retrouvés chez des octogénaires atteints de sclérose en plaques (SP) vivant à domicile ont été comparés à ceux d'individus sans SP du même groupe d'âge et de personnes moins âgées atteintes de SP. Les données provenant des octogénaires atteints de SP (n = 23) et d'un groupe de répondants plus jeunes avec cette maladie (n = 61) ont été tirées d'une enquête canadienne sur le vieillissement avec SP. Les données des groupes avec SP ont été comparées aux statistiques nationales d'octogénaires de la population générale. Les octogénaires avec SP présentaient plus d'incapacités et une prévalence plus élevée de troubles de l'humeur, mais étaient physiquement plus actifs que la population d'octogénaires de l'enquête canadienne. Les octogénaires avec SP ont déclaré éprouver moins de stress et de fatigue que le groupe d'individus plus jeunes avec SP. Bien que la différence d'âge entre les deux groupes avec SP soit d'une dizaine d'années, ces groupes ont rapporté des niveaux similaires de soutien social, d'aisance financière, d'incapacité physique et de participation. Le maintien d'appuis solides (sociaux et financiers), d'une attitude positive, la pratique d'activité physique et la participation aux activités quotidiennes peuvent contribuer au vieillissement dans la collectivité chez les individus avec SP, malgré les défis amenés par cette maladie.

We aimed to determine protective factors distinguishing octogenarians with multiple sclerosis (MS) living at home from others their age and younger people with MS. Data from MS octogenarians (n = 23) and a matched group of MS young-old respondents (n = 61) were extracted from a Canadian MS aging survey. The MS groups were compared, along with a group of octogenarians from the general population, using national statistics. MS octogenarians lived with greater disability and higher prevalence of mood disorders but were more physically active than Canadian octogenarians without MS. MS octogenarians reported less stress and fatigue than the MS young-old group, and despite being more than a decade older, they reported similar levels of social support, financial flexibility, physical disability, and participation. Even when challenged by MS, maintenance of strong supports (social and financial), positive attitude, and participation in physical activity and life roles may contribute to aging in place.

A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality Among Medicare Beneficiaries

OBJECTIVE

We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes.

DESIGN

This is a cohort study with 21,257 community-dwelling Medicare beneficiaries 65 yrs and older who participated in the 2001-2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β coefficients, which were used to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality for 2 yrs of follow-up.

RESULTS

A total of 18 factors were identified for functional deterioration (P < 0.05). In the derivation cohort, the likelihood of functional deterioration ranged from 6.27% to 33.51%, risk of institutionalization from 0.07% to 12.13%, and risk of mortality from 2.13% to 31.83%, in comparison with stable/improved function.

CONCLUSIONS

A risk scoring system predicting Medicare beneficiaries' risk of functional deterioration, institutionalization, and mortality based on demographic and clinical indicators may feasibly be developed with implications for healthcare delivery.

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

BACKGROUND

Prediction models can help clinicians provide the best and most appropriate care to their patients and can help policy makers design services for groups at highest risk for poor outcomes.

OBJECTIVE

To develop prediction models identifying both risk factors and protective factors for functional deterioration, institutionalization, and death.

DESIGN

Cohort study using data from the Medicare Current Beneficiary Survey (MCBS).

SETTING

Community survey.

PARTICIPANTS

This study included 21,264 Medicare beneficiaries 65 years of age and older who participated in the MCBS from the 2001-2008 entry panels and were followed up for 2 years.

METHODS

The index was derived in 60% and validated in the remaining 40%. β Coefficients from a multinomial logistic regression model were used to derive points, which were added together to create scores associated with the outcome.

MAIN OUTCOME MEASURE

The outcome was activity of daily living (ADL) stage transitions over 2 years following entry into the MCBS. Beneficiaries were categorized into 1 of 4 outcome categories: stable or improved function, functional deterioration, institutionalization, or death.

RESULTS

Our model identified 16 factors for functional deterioration (age, gender, education, living arrangement, dual eligibility, proxy use, Alzheimer disease/dementia, angina pectoris/coronary heart disease, diabetes, emphysema/asthma/chronic obstructive pulmonary disease, mental/psychiatric disorder, Parkinson disease, stroke/brain hemorrhage, hearing impairment, vision impairment, and baseline ADL stage) after backward selection (P < .05). Compared to stable or improved function, the risk of functional deterioration ranged from ≤1 to ≥6, ≤4 to ≥22 for the risk of institutionalization, and ≤3 to ≥16 for the risk of death.

CONCLUSION

Predictive indices, or point and scoring systems used to predict outcomes, can identify elderly Medicare beneficiaries at risk for functional deterioration, institutionalization, and death and can aid policy makers, clinicians, and family members in improving care for older adults and supporting successful aging in the community.

LEVEL OF EVIDENCE

III.

Psychosocial Well-Being Associated With Activity of Daily Living Stages Among Community-Dwelling Older Adults

Objectives: Activity of daily living (ADL) stages demonstrated ordered associations with risk of chronic conditions, hospitalization, nursing home use, and mortality among community-living elderly. This article explores the association of stages with psychosocial well-being. We hypothesized that higher ADL stages (greater ADL limitation) are associated with more restricted social networks, less perceived social support, greater social isolation, and poorer mental health. Methods: Cross-sectional data from the National Social Life, Health, and Aging Project (N = 3,002) were analyzed in regression models and latent factor models. Results: Although ADL stages had a nearly monotonic relationship with most mental health measures (e.g., Center for Epidemiologic Studies Depression Scale [CES-D]), only the complete limitation stage (Stage IV) showed significant disadvantage in the majority of social network measures. Discussion: The study may aid clinicians and policy makers to better understand the social and mental health needs of older adults at different ADL stages and provide well-planned social and mental health care.