1
|
Marino M, Deutsch A, Kline T, Smith A, Li Q, Beizer J, McMullen T. Reliability and Validity of the Minimum Data Set 3.0 Standardized Self-Care and Mobility Data Elements Among Long-Stay Nursing Home Residents. Res Gerontol Nurs 2024; 17:57-64. [PMID: 38285909 DOI: 10.3928/19404921-20240112-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
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.].
Collapse
|
2
|
Adam CE, Fitzpatrick AL, Leary CS, Ilango SD, Phelan EA, Semmens EO. The impact of falls on activities of daily living in older adults: A retrospective cohort analysis. PLoS One 2024; 19:e0294017. [PMID: 38170712 PMCID: PMC10763967 DOI: 10.1371/journal.pone.0294017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment. METHOD Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall. RESULTS Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall. CONCLUSIONS Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.
Collapse
Affiliation(s)
- Claire E. Adam
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Annette L. Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Cindy S. Leary
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Sindana D. Ilango
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Elizabeth A. Phelan
- Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Erin O. Semmens
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| |
Collapse
|
3
|
Kodera R, Fujihara K, Koyama T, Shiozaki H, Mutsuma Y, Yagyuda N, Hatta M, Tsuruoka K, Takeda Y, Araki A, Sone H. Impact of a history of cardiovascular disease and physical activity habits on the incidence of functional disability. Sci Rep 2023; 13:20793. [PMID: 38012261 PMCID: PMC10682401 DOI: 10.1038/s41598-023-47913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
We examined the impact of a history of coronary artery disease (CAD) or cerebrovascular disease (CVD) and physical activity habits on functional disability among community-dwelling Japanese adults. This population-based retrospective cohort study included 10,661 people aged 39-98 years in Japan (5054, men). Median follow-up was 3.7 years. During the study period, 209 functional disabilities occurred in the overall study population. In multivariable analysis, a history of CVD (hazard ratio [HR] 1.57 [95% CI: 1.00-2.45]) and no physical activity habit (HR 1.74 [1.27-2.39]) presented increased risks for functional disability. HRs for functional disability among patients with a CVD history with and without a physical activity habit were 1.68 (0.75-3.74) and 2.65 (1.49-4.71), respectively, compared with individuals without a history of CVD with a physical activity habit. Similar results were observed for CAD. We found no significant difference in the incidence of functional disability between the group with a history of CAD or CVD and physical activity habits and the group with no history of CAD or CVD and without physical activity habits. Physical activity habits had a favorable influence on avoiding functional disability regardless of a history of CAD or CVD. Future prospective studies are needed to clarify these associations.
Collapse
Affiliation(s)
- Remi Kodera
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan.
| | - Tetsuya Koyama
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Haruka Shiozaki
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yurie Mutsuma
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Noriko Yagyuda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Mariko Hatta
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Kahori Tsuruoka
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yasunada Takeda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| |
Collapse
|
4
|
Oikonomou P, Dometios A, Khamassi M, Tzafestas CS. Zero-shot model-free learning of periodic movements for a bio-inspired soft-robotic arm. Front Robot AI 2023; 10:1256763. [PMID: 37929074 PMCID: PMC10621048 DOI: 10.3389/frobt.2023.1256763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
In recent years, soft robots gain increasing attention as a result of their compliance when operating in unstructured environments, and their flexibility that ensures safety when interacting with humans. However, challenges lie on the difficulty to develop control algorithms due to various limitations induced by their soft structure. In this paper, we introduce a novel technique that aims to perform motion control of a modular bio-inspired soft-robotic arm, with the main focus lying on facilitating the qualitative reproduction of well-specified periodic trajectories. The introduced method combines the notion behind two previously developed methodologies both based on the Movement Primitive (MP) theory, by exploiting their capabilities while coping with their main drawbacks. Concretely, the requested actuation is initially computed using a Probabilistic MP (ProMP)-based method that considers the trajectory as a combination of simple movements previously learned and stored as a MP library. Subsequently, the key components of the resulting actuation are extracted and filtered in the frequency domain. These are eventually used as input to a Central Pattern Generator (CPG)-based model that takes over the generation of rhythmic patterns at the motor level. The proposed methodology is evaluated on a two-module soft arm. Results show that the first algorithmic component (ProMP) provides an immediate estimation of the requested actuation by avoiding time-consuming training, while the latter (CPG) further simplifies the execution by allowing its control through a low-dimensional parameterization. Altogether, these results open new avenues for the rapid acquisition of periodic movements in soft robots, and their compression into CPG parameters for long-term storage and execution.
Collapse
Affiliation(s)
- Paris Oikonomou
- Division of Signals, Control and Robotics, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Athanasios Dometios
- Division of Signals, Control and Robotics, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Mehdi Khamassi
- Division of Signals, Control and Robotics, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
- Sorbonne Université, Centre National de la Recherche Scientifique, Institute of Intelligent Systems and Robotics, Paris, France
| | - Costas S Tzafestas
- Division of Signals, Control and Robotics, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| |
Collapse
|
5
|
Khayatzadeh-Mahani M, Riyahi S, Amiri E, Ahmadi Angali K. Effects of Bathing Skills Training on Independence and Satisfaction of Older Adults Living in a Nursing Home: A Randomized Controlled Trial. Med J Islam Repub Iran 2023; 37:103. [PMID: 38021382 PMCID: PMC10657268 DOI: 10.47176/mjiri.37.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Indexed: 12/01/2023] Open
Abstract
Background Dependence in bathing is the most common activities of daily living (ADLs) dependency among older adults. The aim of this study was to evaluate the effect of bathing skills training on the independence and satisfaction of older adults living in nursing homes. Methods In this randomized controlled trial, 80 participants were assigned randomly to the intervention (n = 40) and control groups (n = 40). The intervention group received 10 weekly bathing skills training sessions, with each session lasting about 60 minutes, while the control group received no direct training. The evaluation was conducted using the Modified Barthel Index (MBI) and the Canadian Occupational Performance Measure (COPM). Analysis of variance for repeated measurements was used to test the effect of intervention at the baseline, post-intervention, and follow-up. Results The mean improvement in the MBI was greater for the intervention group (P < 0.001; partial η2 = 0.34), which remained significant at the follow-up (P < 0.001; partial η2 = 0.41). The greater mean change of the COPM-Performance was significant in the intervention group (P < 0.001; partial η2 = 0.17), which remained significant at the follow-up (P < 0.001; partial η2 = 0.19). The greater mean improvement of the COPM-Satisfaction was observed for the intervention group (P < 0.001; partial η2 = 0.36), which remained at the follow-up (P = 0.001; partial η2 = 0.42). Conclusion Bathing skills training is effective in improving the ADLs independence and satisfaction in older adults living in nursing homes; thus, it is recommended to be included in the schedules of nursing homes.
Collapse
Affiliation(s)
- Mohammad Khayatzadeh-Mahani
- Department of Occupational Therapy, Musculoskeletal Rehabilitation Research
Center, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran
| | - Sepide Riyahi
- Department of Occupational Therapy, Musculoskeletal Rehabilitation Research
Center, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran
| | - Elham Amiri
- Department of Occupational Therapy, Musculoskeletal Rehabilitation Research
Center, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran
| | - Kambiz Ahmadi Angali
- Department of Biostatistics and Epidemiology, School of Health, Environmental
Technology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
6
|
‘Can't always get what you want’: Allocation of community-based services for older adults. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
7
|
Multimorbidity, depressive symptoms and disability in activities of daily living amongst middle-aged and older Chinese: Evidence from the China Health and Retirement Longitudinal Study. J Affect Disord 2021; 295:703-710. [PMID: 34517243 DOI: 10.1016/j.jad.2021.08.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/09/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given that multimorbidity is strongly associated with disability in activities of daily living (ADL) and the mechanism still remains unclear, this study sought to investigate the mediating effect of depressive symptoms on such association. METHODS A longitudinal dataset was drawn from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015), including 3951 adults aged 45 years and above. By sex, logistic regression and mediation analysis (the Karlson, Holm, and Breen Method) were employed. RESULTS The presence of multimorbidity was associated with increased odds of having depressive symptoms and developing ADL disability, and depressive symptoms was significantly associated with ADL disability among middle-aged and older women. Mediation analysis illustrated that depressive symptoms accounted for 6.36% of the effect of multimorbidity on ADL disability in women. LIMITATIONS Results might not generalize to all middle-aged and older Chinese due to missing data on depressive symptoms and ADL. CONCLUSIONS Multimorbidity increased the likelihood of ADL disability onset partially through depressive symptoms in middle-aged and older women, suggesting that emphasizing mental wellness of females with multimorbidity are necessary to prevent impairments in physical function.
Collapse
|
8
|
Jacobs JC, Wagner TH, Trivedi R, Lorenz K, Van Houtven CH. Long-term care service mix in the Veterans Health Administration after home care expansion. Health Serv Res 2021; 56:1126-1136. [PMID: 34085283 PMCID: PMC8586480 DOI: 10.1111/1475-6773.13687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/02/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether the Veterans Health Administration's (VHA) efforts to expand access to home- and community-based services (HCBS) after the 2001 Millennium Act significantly changed Veterans' utilization of institutional, paid home, and unpaid home care relative to a non-VHA user Medicare population that was not exposed to HCBS expansion efforts. DATA SOURCES We used linkages between the Health and Retirement Study and VHA administrative data from 1998 until 2012. STUDY DESIGN We conducted a retrospective-matched cohort study using coarsened exact matching to ensure balance on observable characteristics for VHA users (n = 943) and nonusers (n = 6106). We used a difference-in-differences approach with a person fixed-effects estimator. DATA COLLECTION/EXTRACTION METHODS Individuals were eligible for inclusion in the analysis if they were age 65 or older and indicated that they were covered by Medicare insurance in 1998. Individuals were excluded if they were covered by Medicaid insurance at baseline. Individuals were considered exposed to VHA HCBS expansion efforts if they were enrolled in the VHA and used VHA services. PRINCIPAL FINDINGS Theory predicts that an increase in the public allocation of HCBS will decrease the utilization of its substitutes (e.g., institutional care and unpaid caregiving). We found that after the Millennium Act was passed, there were no observed differences between VHA users and nonusers in the probability of using institutional long-term care (0.7% points, 95% CI: -0.009, 0.022) or in receiving paid help with activities of daily living (0.06% points, 95% CI: -0.011, 0.0125). VHA users received more hours of unpaid care post-Millennium Act (1.48, 95% CI: -0.232, 3.187), though this effect was not significant once we introduced controls for mental health. CONCLUSIONS Our findings indicate that mandating access to HCBS services does not necessarily imply that access to these services will follow suit.
Collapse
Affiliation(s)
- Josephine C. Jacobs
- Health Economics Resource CenterVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Center for Innovation to Implementation, VA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Outcomes ResearchStanford University School of MedicineStanfordCaliforniaUSA
| | - Todd H. Wagner
- Health Economics Resource CenterVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Center for Innovation to Implementation, VA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Departments of SurgeryStanford University School of MedicineStanfordCaliforniaUSA
| | - Ranak Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Karl Lorenz
- Center for Innovation to Implementation, VA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Section of Palliative Care, Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Courtney H. Van Houtven
- Center of Innovation to Accelerate Discovery and Practice TransformationDurham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
- Duke‐Margolis Center for Health PolicyDuke UniversityDurhamNorth CarolinaUSA
| |
Collapse
|
9
|
Nari F, Jeong W, Jang BN, Lee HJ, Park EC. Association between healthy lifestyle score changes and quality of life and health-related quality of life: a longitudinal analysis of South Korean panel data. BMJ Open 2021; 11:e047933. [PMID: 34675011 PMCID: PMC8532554 DOI: 10.1136/bmjopen-2020-047933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We aimed to determine the influence of changes in the aggregate score of healthy lifestyle factors on health-related quality of life (HRQOL) and overall quality of life (QOL) in the Korean older adult population. DESIGN This study used a longitudinal design. SETTING AND PARTICIPANTS Data on 9474 participants aged 45 years or older were extracted from the Korean Longitudinal Study on Aging for the period 2006-2016. A composite score of four lifestyle factors (smoking, drinking, physical activity and body mass index) was calculated, and biennial changes in aggregate score were computed. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were HRQOL and QOL. RESULTS Generalised estimating equation analysis results showed that those with healthy lifestyle score changes from 'Low-High' (β =-0.987, p=0.002; β =-1.288, p<0.0001), 'High-Low' (β =-1.281, p<0.0001; β =-1.952, p<0.0001) and 'Low-Low' (β =-1.552, p<0.0001; β =-2.398, p<0.0001) groups were more likely to be have lower HRQOL and QOL estimates than those in 'High-High' group. Female gender, older age and depression had a more negative impact on HRQOL, while male gender and younger age had a more negative impact on QOL, especially in the Low-Low group. The relationship between changes in scores and HRQOL and QOL varied across different elements of healthy lifestyle scores. Changes in physical activity, drinking and smoking status were significantly associated with lower HRQOL and QOL. CONCLUSION The findings suggest an association between a low healthy lifestyle score and poor quality of life, in both general and health-related aspects. Strategies targeting the Korean ageing demographic to promote a healthier lifestyle should be encouraged.
Collapse
Affiliation(s)
- Fatima Nari
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Wonjeong Jeong
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Bich Na Jang
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Hyeon Ji Lee
- Department of Public Health, Graduate School, Yonsei University, Seodaemun-gu, Korea (the Republic of)
- Yonsei University Institute of Health Services Research, Seodaemun-gu, Korea (the Republic of)
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
| |
Collapse
|
10
|
Do VQ, Draper B, Harvey L, Driscoll T, Braithwaite J, Brodaty H, Mitchell R. Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community. Arch Osteoporos 2021; 16:120. [PMID: 34405278 DOI: 10.1007/s11657-021-00966-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/06/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture. OBJECTIVE To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs. METHODS A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008-2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions. RESULTS There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers. CONCLUSION Health service use trajectories differed for RACF residents and community-dwellers; however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.
Collapse
Affiliation(s)
- Vu Quang Do
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia.
| | - Brian Draper
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration - Assessment and Better Care, University of New South Wales, Sydney, Australia
| | - Lara Harvey
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Tim Driscoll
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
| | - Henry Brodaty
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,Dementia Centre for Research Collaboration - Assessment and Better Care, University of New South Wales, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
| |
Collapse
|
11
|
Fong JH. Rasch analysis highlighted relative importance of walking and transferring disabilities among elderly in developing countries. J Clin Epidemiol 2021; 139:121-129. [PMID: 34363969 DOI: 10.1016/j.jclinepi.2021.07.020] [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] [Received: 02/13/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study examines hierarchical patterns of progression in activities of daily living (ADL) disabilities among older adults in low- and middle-income countries. STUDY DESIGN AND SETTING Data from WHO's SAGE survey (2007-2010) on adults aged 60 and above in China, India, Russia, Ghana, Mexico, and South Africa, were analyzed. We used factor analysis and Rasch modelling to develop ADL hierarchies for cross-national comparisons. RESULTS Data fitted the Rasch model well and Cronbach's α were 0.80-0.87 across countries. Based on scaled logit scores, "walking" was the most difficult item for older adults in five of the six countries. Older persons in developing countries also found "transferring" to/from beds challenging. "Eating" and "dressing" ranked lower in the hierarchies, thus perceived as easier than other activities. Sequences were most compact for China, Mexico, and India, implying that older adults in these countries who have difficulty "walking" are at high risk of developing the rest of the disabilities. CONCLUSION This is the first study that used Rasch analysis to demonstrate that functional loss sequences in various developing countries share certain broad similarities. Interventions targeted at improving walking and transferring activities can help offset certain deficits in independent functioning for community-dwelling elderly in these countries.
Collapse
Affiliation(s)
- Joelle H Fong
- National University of Singapore, Singapore 259771, Singapore.
| |
Collapse
|
12
|
Prusynski RA, Frogner BK, Skillman SM, Dahal A, Mroz TM. Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities. J Appl Gerontol 2021; 41:352-362. [PMID: 34291695 DOI: 10.1177/07334648211033417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.
Collapse
|
13
|
Fettes L, Bone AE, Etkind SN, Ashford S, Higginson IJ, Maddocks M. Disability in Basic Activities of Daily Living Is Associated With Symptom Burden in Older People With Advanced Cancer or Chronic Obstructive Pulmonary Disease: A Secondary Data Analysis. J Pain Symptom Manage 2021; 61:1205-1214. [PMID: 33096219 DOI: 10.1016/j.jpainsymman.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Managing activities of daily living is important to people with advanced cancer or chronic obstructive pulmonary disease (COPD). Understanding disability in activities of daily living may inform service planning. OBJECTIVE To identify the prevalence of disability in activities of daily living, associations and change over time, in older people with advanced cancer or COPD. METHODS Secondary analysis of International Access, Rights and Empowerment (IARE) studies in adults aged ≥65 years with advanced disease in the United Kingdom, Ireland, and United States, using cross-sectional (IARE I & II) and longitudinal (IARE II, 3 timepoints over 6 months) data. Measures included disability in activities of daily living (Barthel Index), symptom severity (Palliative Outcome Scale), and assistive device use (self-reported). Logistic regression was used to identify relationships between disability and age, sex, living alone, diagnosis, and symptom burden; visual graphical analysis explores individual disability trajectories. RESULTS One hundred fifty-nine participants were included (140 cancer, 19 COPD). Sixty-five percent had difficulty climbing stairs, 48% bathing, 39% dressing, and 36% mobilizing. Increased disability was independently associated with increased symptom burden (odds ratio, 1.08 [95% CI:1.02-1.15], P = 0.01) and walking unaided (z = 2.35, P = 0.02), but not with primary diagnosis (z = -0.47, P = 0.64). Disability generally increased over time but with wide interindividual variation. CONCLUSION Disability in activities of daily living in advanced cancer or COPD is common, associated with increased symptom burden, and may be attenuated by use of assistive devices. Individual disability trajectories vary widely, with diverse disability profiles. Services should include rehabilitative interventions, guided by disability in individual activities of daily living.
Collapse
Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK.
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK; Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK; Centre for Nursing Midwifery and Allied health Research and the National Hospital for Neurology and Neurosurgery, University College London Hospitals, Holborn, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, UK
| |
Collapse
|
14
|
Wild K, Sharma N, Mattek N, Karlawish J, Riley T, Kaye J. Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study. J Med Internet Res 2021; 23:e18806. [PMID: 33439144 PMCID: PMC7840292 DOI: 10.2196/18806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/23/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.
Collapse
Affiliation(s)
- Katherine Wild
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Nicole Sharma
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Nora Mattek
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Jason Karlawish
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas Riley
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| | - Jeffrey Kaye
- Department of Neurology, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
- Department of Biomedical Engineering, Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, United States
| |
Collapse
|
15
|
Fettes L, Bayly J, de Bruin LM, Patel M, Ashford S, Higginson IJ, Maddocks M. Relationships between prolonged physical and social isolation during the COVID-19 pandemic, reduced physical activity and disability in activities of daily living among people with advanced respiratory disease. Chron Respir Dis 2021; 18:14799731211035822. [PMID: 34382888 PMCID: PMC8370888 DOI: 10.1177/14799731211035822] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In people with advanced respiratory disease, we examined (i) the impact of COVID-19-related physical and social isolation on physical activity and (ii) relationships between time spent in isolation and disability in activities of daily living. Cross-sectional analysis was conducted in adults with advanced non-small cell lung cancer, chronic obstructive lung disease or interstitial lung disease. Measures included change in physical activity since physically and socially isolating (Likert scale) and disability (Barthel Index and Lawton-Brody IADL scale) or difficulty (World Health Organisation Disability Assessment Schedule-2.0) in daily activities. Multiple logistic regression was used to examine factors associated with disability in daily activities. 194/201 participants were isolating for a median [IQR] 5 [3-8]-month period, often leading to lower levels of physical activity at home (n = 94, 47%), and outside home (n = 129, 65%). 104 (52%) and 142 (71%) were not fully independent in basic and instrumental activities of daily living, respectively. 96% reported some degree of difficulty in undertaking daily activities. Prolonged physical and social isolation related to increased disability in basic (r = -0.28, p < 0.001) and instrumental (r = -0.24, p < 0.001) activities of daily living, and greater difficulty in daily activities (r = 0.22, p = 0.002). Each month spent in physical or social isolation was independently related to disability in basic activities of daily living (odds ratio [OR], 1.17 [95% CI: 1.03-1.33], p = 0.013). These findings suggest disability in daily activities is associated with prolonged physical or social isolation, which may present as difficulty in people who are fully independent. Post-isolation recovery and rehabilitation needs should be considered for all people deemed extremely clinically vulnerable.
Collapse
Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Leonora Michelle de Bruin
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Malini Patel
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK.,Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, London, UK.,Centre for Nursing Midwifery and Allied health Research and the National Hospital for Neurology and Neurosurgery, 8964University College London Hospitals, Holborn, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, 4616King's College London, London, UK
| |
Collapse
|
16
|
Sullivan J, Shih TM, van Eijndhoven E, Jalundhwala YJ, Lakdawalla DN, Zadikoff C, Benner J, Marshall TS, Sail KR. The Social Value of Improvement in Activities of Daily Living among the Advanced Parkinson's Disease Population. Forum Health Econ Policy 2020; 23:1-23. [PMID: 33984886 DOI: 10.1515/fhep-2019-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Quantify the value of functional status (FS) improvements consistent in magnitude with improvements due to levodopa-carbidopa intestinal gel (LCIG) treatment, among the advanced Parkinson's disease (APD) population. METHODS The Health Economic Medical Innovation Simulation (THEMIS), a microsimulation that estimates future health conditions and medical spending, was used to quantify the health and cost burden of disability among the APD population, and the value of quality-adjusted life-years gained from FS improvement due to LCIG treatment compared to standard of care (SoC). A US-representative Parkinson's disease (PD)-comparable cohort was constructed in THEMIS based on observed PD patient characteristics in a nationally representative dataset. APD was defined from the literature and clinical expert input. The PD and APD cohorts were followed from 2010 over their remaining lifetimes. All individuals were ages 65 and over at the start of the simulation. To estimate the value of FS improvement due to LCIG treatment, decreases in activities of daily living (ADL) limitations caused by LCIG treatment were calculated using data from a randomized, controlled, double-blind, double-dummy clinical trial and applied to the APD population in THEMIS. RESULTS Total burden of disability associated with APD was $17.7 billion (B). From clinical trial data, LCIG treatment versus SoC lowers the odds of difficulties in walking, dressing, and bathing by 76%, 42% and 39%, respectively. Among the APD population, these reductions generated $2.6B in value to patients and cost savings to payers. The added value was 15% of the burden of disability associated with APD and offsets 15% of the cost of LCIG treatment. CONCLUSIONS FS improvements, consistent with improvements due to LCIG treatment, in the APD population created health benefits and reduced healthcare costs in the US.
Collapse
Affiliation(s)
- Jeffrey Sullivan
- PRECISIONheor, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA 90025, USA
| | - Tiffany M Shih
- PRECISIONheor, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA 90025, USA
| | - Emma van Eijndhoven
- PRECISIONheor, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA 90025, USA
| | - Yash J Jalundhwala
- AbbVie, Health Economics and Outcomes Research, 1 North Waukegan Rd, D-GMH1, AP31-1E, North Chicago, IL 60064, USA
| | - Darius N Lakdawalla
- PRECISIONheor, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA 90025, USA
| | - Cindy Zadikoff
- AbbVie, Health Economics and Outcomes Research, 1 North Waukegan Rd, D-GMH1, AP31-1E, North Chicago, IL 60064, USA.,Feinberg School of Medicine, Northwestern University, Abbott Hall Suite 1123, 710 N Lake Shore Drive, Chicago, IL 60611, USA
| | - Jennifer Benner
- PRECISIONheor, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA 90025, USA
| | - Thomas S Marshall
- AbbVie, Health Economics and Outcomes Research, 1 North Waukegan Rd, D-GMH1, AP31-1E, North Chicago, IL 60064, USA
| | - Kavita R Sail
- AbbVie, Health Economics and Outcomes Research, 1 North Waukegan Rd, D-GMH1, AP31-1E, North Chicago, IL 60064, USA
| |
Collapse
|
17
|
Hang JA, Francis-Coad J, Naseri C, Waldron N, Hill AM. Effects of facility-based transition care programs on health-related outcomes in older adults: a systematic review protocol. JBI Evid Synth 2020; 18:2425-2434. [PMID: 32813419 DOI: 10.11124/jbisrir-d-19-00240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVE The objective of the review is to synthesize the best available evidence on the effects of transition care rehabilitation programs on health-related outcomes in older adults admitted to a transition care facility. INTRODUCTION Approximately 30% of older adults admitted to hospital experience functional decline after hospital discharge. To enable older adults to return to independent community living after hospitalization, transition care programs (TCPs) that focus on promoting safe recovery and maximizing older adults' functional ability have been developed. Limited studies have examined whether undertaking TCPs after hospitalization result in improved health-related outcomes in older adults compared to usual discharge care. INCLUSION CRITERIA Studies that include participants 65 years of age or older, deliver TCPs in a facility-based setting, and report health-related outcomes will be included. Randomized and quasi-controlled study designs as well as observational cohort designs with pre-post outcomes will be included. METHODS A three-step search strategy will be utilized. Databases that will be searched are PubMed, CINAHL (EBSCO), AMED (Ovid), PsycINFO, and Embase (Ovid). Studies published after 2000 will be included. Results of the search strategy will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. Data extracted will include population characteristics, study design, duration, and intensity of the TCP, and health-related outcomes significant to the review question, including the discharge destination from TCPs (independent community living, residential aged care, or hospital). Quantitative data, where possible, will be pooled in statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020177623.
Collapse
Affiliation(s)
- Jo-Aine Hang
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, WA, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, WA, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, WA, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Chiara Naseri
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, WA, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, WA, Australia
| | - Nicholas Waldron
- Department of Aged Care and Rehabilitation, Armadale Kelmscott Memorial Hospital, East Metropolitan Health Service, Perth, WA, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, WA, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, WA, Australia
| |
Collapse
|
18
|
Simning A, Orth J, Temkin-Greener H, Li Y. Patients discharged from higher-quality skilled nursing facilities spend more days at home. Health Serv Res 2020; 56:102-111. [PMID: 32844434 DOI: 10.1111/1475-6773.13543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the association of skilled nursing facility (SNF) quality with days spent alive in nonmedical settings ("home time") after SNF discharge to the community. DATA SOURCES Secondary data are from Medicare claims for New York State (NYS) Medicare beneficiaries, the Area Health Resources File, and Nursing Home Compare. STUDY DESIGN We estimate home time in the 30- and 90-day periods following SNF discharge. Two-part zero-inflated negative binomial regression models characterize the association of SNF quality with home time. DATA EXTRACTION METHODS We use Medicare claims data to identify 25 357 NYS fee-for-service Medicare beneficiaries aged 65 years and older with an SNF admission for postacute care who were subsequently discharged to home in 2014. PRINCIPAL FINDINGS Following 30 and 90 days after SNF discharge, the average home time is 28.0 (SD = 6.1) and 81.6 (SD = 20.2) days, respectively. A number of patient- and SNF-level factors are associated with home time. In particular, within 30 and 90 days of discharge, respectively, patients discharged from 2- to 5-star SNFs spend 1.2-1.5 (P < .001) and 3.2-4.3 (P < .001) more days at home than those discharged from 1-star (lowest quality) SNFs. CONCLUSIONS Improved understanding of what is contributing to differences in home time could help guide efforts into optimizing post-SNF discharge outcomes.
Collapse
Affiliation(s)
- Adam Simning
- Department of Psychiatry, University of Rochester Medical Center (URMC), Rochester, New York.,Department of Public Health Sciences, URMC, Rochester, New York
| | - Jessica Orth
- Department of Public Health Sciences, URMC, Rochester, New York
| | | | - Yue Li
- Department of Public Health Sciences, URMC, Rochester, New York
| |
Collapse
|
19
|
Abstract
Dementia is characterized by a decline in memory, language, problem-solving and in other cognitive domains that affect a person's ability to perform everyday activities and social functioning. It is consistently agreed that cognitive impairment is an important risk factor for developing functional disabilities in patients with dementia. Functional status can be conceptualized as the ability to perform self-care, self- maintenance and physical activity. A person with dementia usually requires help with more complex tasks, such as managing bills and finances, or simply maintaining a household. Good functional performance is fundamental for elderly people to maintain independency and avoid institutionalization. The purpose of this review is to describe functional changes in demented patients, evaluating the variability in subgroups of dementias.
Collapse
Affiliation(s)
- Gabriele Cipriani
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy.,MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
| | - Sabrina Danti
- PhD, Clinical and Health Psychology Unit, Hospital of Pontedera, Pontedera (PI), Italy
| | - Lucia Picchi
- PsyD, Clinical Psychology Unit, Hospital of Leghorn, Leghorn (LI), Italy
| | - Angelo Nuti
- MD,Versilia Hospital, Neurology Unit, Lido di Camaiore (Lu), Italy
| | - Mario Di Fiorino
- MD, Versilia Hospital, Psychiatry Unit, Lido di Camaiore (Lu), Italy
| |
Collapse
|
20
|
Fong JH, Kok ZC. Does subjective health matter? Predicting overall and specific ADL disability incidence. Arch Gerontol Geriatr 2020; 90:104169. [PMID: 32645561 DOI: 10.1016/j.archger.2020.104169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/28/2020] [Accepted: 06/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aims of this study were to examine the incidence of activities of daily living (ADL) and instrumental activities of daily living (IADL) disability in a national sample of community-living older adults, and to evaluate the value of baseline self-rated health (SRH) in predicting these outcomes. Additionally, we investigated whether SRH's prognostic ability extended to individual ADL/IADL components (e.g. bathing, managing money). METHODS Data were obtained from the 2014 and 2016 Korean Longitudinal Study of Aging (N = 3431). Respondents were aged 65+ and non-disabled at baseline. Setting the respondents with "very good" or "good" baseline SRH as the reference group, logistic regression models were applied to analyze the association between SRH and disability risk. RESULTS The overall incidence rates for ADL and IADL were 25.6 and 53.4/1000 person-years, respectively. Disability incidence increased significantly with poorer SRH. In multivariable regressions, subsequent 1 + ADL disability was significantly associated with "bad" (OR 2.86) and "very bad" SRH (OR 4.28). SRH also predicted 1 + IADL disability for respondents who reported "moderate", "bad", or "very bad" health (OR 2.01-3.39). SRH was predictive of three out of five ADL components, and seven out of 10 IADL components. CONCLUSION SRH predicted functional decline after two years in older adults without baseline disabilities, and its prognostic ability extended to individual ADL/IADL components. Patterns of SRH-morbidity associations can help health administrators identify those at risk of subsequent functional decline. Early interventions targeted at those with poor SRH can help alleviate the strain on long-term care support systems.
Collapse
Affiliation(s)
- Joelle H Fong
- National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore.
| | - Zi-Cheng Kok
- National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore.
| |
Collapse
|
21
|
Shih TM, Sail KR, Jalundhwala YJ, Sullivan J, van Eijndhoven E, Zadikoff C, Marshall TS, Lakdawalla DN. The effect of functional status impairment on nursing home admission risk among patients with advanced Parkinson's disease. J Med Econ 2020; 23:297-307. [PMID: 31779508 DOI: 10.1080/13696998.2019.1693383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: To estimate the relationship between functional status (FS) impairment and nursing home admission (NHA) risk in Parkinson's disease (PD) patients, and quantify the effect of advanced PD (APD) treatment on NHA risk relative to standard of care (SoC).Materials and methods: PD patients were identified in the Medicare Current Beneficiary Survey (MCBS) (1992-2010). A working definition based on the literature and clinical expert input determined APD status. A logit model estimated the relationship between FS impairment and NHA risk. The effect of levodopa-carbidopa intestinal gel (LCIG) on NHA risk relative to SoC was simulated using clinical trial data (control: optimized oral levodopa-carbidopa IR, ClinicalTrials.gov NCT00660387 and NCT0357994).Results: Non-advanced PD and APD significantly increased NHA risk when controlling for demographics (p < 0.01). APD status was no longer significant after controlling for FS limitations, implying that FS limitations explain the increased NHA risk in APD patients. Reduced impairment in FS in patients with APD treated with LCIG reduced risk of NHA by 13.5% relative to SoC.Limitations: This study applies clinical trial results to real-world data. LCIG treatment might have a different effect on NHA risk for the nationally representative population than the effect measured in the trial. Both data sources employ different instruments to measure FS, instrument wording and study follow-up differed, which might bias our estimates. Finally, there lacks consensus on a definition of APD. The prevalence of APD in this study is high, perhaps due to the specific definition used.Conclusions: Patients with APD experience a higher risk in NHA than those with non-advanced disease. This increased risk in NHA in patients with APD is explained by greater limitations in FS. The relative reduction in risk of NHA for the APD population treated with LCIG is quantitatively similar to doubling Medicaid home care services.
Collapse
Affiliation(s)
| | | | | | | | | | - Cindy Zadikoff
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | |
Collapse
|
22
|
Galof K, Žnidaršič A, Balantič Z. Independence and Caregiver Preferences Among Community-Dwelling Older People in Slovenia: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019869155. [PMID: 31394962 PMCID: PMC6689914 DOI: 10.1177/0046958019869155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although Slovenia is becoming an aging society, very little is known about the abilities and needs of home-dwelling older people or their preferences regarding assistance. The aim of the study was to explore the need for assistance in daily activities among older Slovenian people living at home. Older adults aged between 65 and 97 years (N = 358) participated in the cross-sectional survey study. A questionnaire that assessed independence in daily activities and assistance in the home environment was developed. Data were analyzed using descriptive statistics, a nonparametric test (Wilcoxon signed rank test), and the chi-square test. The results showed that older Slovenians were more independent in activities of daily living (ADLs) than instrumental activities of daily living (IADLs). Independence was the highest for using the toilet, feeding, and mobility transfers, and the lowest for bathing. With IADLs, assistance was most often required with shopping and housework; this assistance was usually provided by family members. The provider of assistance was generally compatible with older people’s preferences concerning assistance at home. We found no differences in care preferences between urban and rural settings. Assistance in the home environment was predominantly provided by unpaid helpers, which reflects recent developments in health and social services that put an emphasis on a person’s social network. Due to demographic changes and the decrease in the number of adult children, reliance on close relatives might soon become a challenge. These findings can help policy makers understand older people’s choices and preferences better when planning long-term care.
Collapse
Affiliation(s)
- Katarina Galof
- 1 University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
| | - Anja Žnidaršič
- 2 University of Maribor, Faculty of Organizational Sciences, Kranj, Slovenia
| | - Zvone Balantič
- 2 University of Maribor, Faculty of Organizational Sciences, Kranj, Slovenia
| |
Collapse
|
23
|
Improving gesture-based interaction between an assistive bathing robot and older adults via user training on the gestural commands. Arch Gerontol Geriatr 2019; 87:103996. [PMID: 31855713 DOI: 10.1016/j.archger.2019.103996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/21/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gesture-based human-robot interaction (HRI) depends on the technical performance of the robot-integrated gesture recognition system (GRS) and on the gestural performance of the robot user, which has been shown to be rather low in older adults. Training of gestural commands (GCs) might improve the quality of older users' input for gesture-based HRI, which in turn may lead to an overall improved HRI. OBJECTIVE To evaluate the effects of a user training on gesture-based HRI between an assistive bathing robot and potential elderly robot users. METHODS Twenty-five older adults with bathing disability participated in this quasi-experimental, single-group, pre-/post-test study and underwent a specific user training (10-15 min) on GCs for HRI with the assistive bathing robot. Outcomes measured before and after training included participants' gestural performance assessed by a scoring method of an established test of gesture production (TULIA) and sensor-based gestural performance (SGP) scores derived from the GRS-recorded data, and robot's command recognition rate (CRR). RESULTS Gestural performance (TULIA = +57.1 ± 56.2 %, SGP scores = +41.1 ± 74.4 %) and CRR (+31.9 ± 51.2 %) significantly improved over training (p < .001). Improvements in gestural performance and CRR were highly associated with each other (r = 0.80-0.81, p < .001). Participants with lower initial gestural performance and higher gerontechnology anxiety benefited most from the training. CONCLUSIONS Our study highlights that training in gesture-based HRI with an assistive bathing robot is highly beneficial for the quality of older users' GCs, leading to higher CRRs of the robot-integrated GRS, and thus to an overall improved HRI.
Collapse
|
24
|
Edjolo A, Pérès K, Guerchet M, Pilleron S, Ndamba-Bandzouzi B, Mbelesso P, Clément JP, Dartigues JF, Preux PM. Development of the Central Africa Daily Functioning Interference Scale for Dementia Diagnosis in Older Adults: The EPIDEMCA Study. Dement Geriatr Cogn Disord 2019; 47:29-41. [PMID: 30630171 DOI: 10.1159/000492782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are a few validated tools capable of assessing the dimensions essential for the diagnosis of dementia and cognitive disorders in sub-Saharan Africa. OBJECTIVES Our aim was to develop an adapted tool, the Central African - Daily Functioning Interference (DFI) scale. METHODS An initial 16-item scale of activity limitations and participation restrictions was completed by 301 participants with low cognitive performances to assess their level of DFI. A psychometric evaluation was performed using Item Response Theory. RESULTS A unidimensional 10-item scale emerged with a reasonable coverage of DFI (thresholds range: -1.067 to 1.587) with good item discrimination properties (1.397-4.076) and a high reliability (Cronbach's al pha = 0.92). The cutoff for detecting 96% of those with dementia was with a latent score ≥0.035 that corresponds to the LAUNDRY limitation. CONCLUSIONS These results provide valuable support for the reliability and internal validity of an operational 10-item scale for DFI assessment used in Central Africa for the diagnosis of dementia in the elderly.
Collapse
Affiliation(s)
- Arlette Edjolo
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France, .,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France,
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Maëlenn Guerchet
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,King's College London, Centre for Global Mental Health, Institute of Psychiatry, Health Service and Population Research Department, London, United Kingdom
| | - Sophie Pilleron
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France
| | | | - Pascal Mbelesso
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,Department of Neurology, Brazzaville University Hospital, Brazzaville, Congo
| | - Jean-Pierre Clément
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,Hospital and University Federation of Adult and Geriatric Psychiatry, Limoges, France
| | - Jean-François Dartigues
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Pierre-Marie Preux
- University Limoges, School of Medicine, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.,INSERM UMR 1094, Tropical Neuroepidemiology, Faculty of Medicine, Limoges, France.,CHU, Department of Medical Information and Evaluation, Clinical Research and Biostatistics Unit, Limoges, France
| | | |
Collapse
|
25
|
Hajduk AM, Murphy TE, Geda ME, Dodson JA, Tsang S, Haghighat L, Tinetti ME, Gill TM, Chaudhry SI. Association Between Mobility Measured During Hospitalization and Functional Outcomes in Older Adults With Acute Myocardial Infarction in the SILVER-AMI Study. JAMA Intern Med 2019; 179:1669-1677. [PMID: 31589285 PMCID: PMC6784755 DOI: 10.1001/jamainternmed.2019.4114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
Importance Many older survivors of acute myocardial infarction (AMI) experience functional decline, an outcome of primary importance to older adults. Mobility impairment has been proposed as a risk factor for functional decline but has not been evaluated to date in older patients hospitalized for AMI. Objective To examine the association of mobility impairment, measured during hospitalization, as a risk marker for functional decline among older patients with AMI. Design, Setting, and Participants Prospective cohort study among 94 academic and community hospitals in the United States. Participants were 2587 hospitalized patients with AMI who were 75 years or older. The study dates were January 2013 to June 2017. Main Outcomes and Measures Mobility was evaluated during AMI hospitalization using the Timed "Up and Go," with scores categorized as preserved mobility (≤15 seconds to complete), mild impairment (>15 to ≤25 seconds to complete), moderate impairment (>25 seconds to complete), and severe impairment (unable to complete). Self-reported function in activities of daily living (ADLs) (bathing, dressing, transferring, and walking around the home) and walking 0.4 km (one-quarter mile) was assessed at baseline and 6 months after discharge. The primary outcomes were worsening of 1 or more ADLs and loss of ability to walk 0.4 km from baseline to 6 months after discharge. The association between mobility impairment and risk of functional decline was evaluated with multivariable-adjusted logistic regression. Results Among 2587 hospitalized patients with AMI, the mean (SD) age was 81.4 (4.8) years, and 1462 (56.5%) were male. More than half of the cohort exhibited mobility impairment during AMI hospitalization (21.8% [564 of 2587] had mild impairment, 16.0% [414 of 2587] had moderate impairment, and 15.2% [391 of 2587] had severe impairment); 12.8% (332 of 2587) reported ADL decline, and 16.7% (431 of 2587) reported decline in 0.4-km mobility. Only 3.8% (30 of 800) of participants with preserved mobility experienced any ADL decline compared with 6.9% (39 of 564) of participants with mild impairment (adjusted odds ratio [aOR], 1.24; 95% CI, 0.74-2.09), 18.6% (77 of 414) of participants with moderate impairment (aOR, 2.67; 95% CI, 1.67-4.27), and 34.7% (136 of 391) of participants with severe impairment (aOR, 5.45; 95% CI, 3.29-9.01). Eleven percent (90 of 800) of participants with preserved mobility declined in ability to walk 0.4 km compared with 15.2% (85 of 558) of participants with mild impairment (aOR, 1.51; 95% CI, 1.04-2.20), 19.0% (78 of 411) of participants with moderate impairment (aOR, 2.03; 95% CI, 1.37-3.02), and 24.6% (95 of 386) of participants with severe impairment (aOR, 3.25; 95% CI, 2.02-5.23). Conclusions and Relevance This study's findings suggest that mobility impairment assessed during hospitalization may be a potent risk marker for functional decline in older survivors of AMI. These findings also suggest that brief, validated assessments of mobility should be part of the care of older hospitalized patients with AMI to identify those at risk for this important patient-centered outcome.
Collapse
Affiliation(s)
- Alexandra M. Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terrence E. Murphy
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Geda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - John A. Dodson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sui Tsang
- Department of Medicine, NYU Langone Health, New York, New York
| | - Leila Haghighat
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Tinetti
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
26
|
Fong JH. Disability incidence and functional decline among older adults with major chronic diseases. BMC Geriatr 2019; 19:323. [PMID: 31752701 PMCID: PMC6873710 DOI: 10.1186/s12877-019-1348-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/06/2019] [Indexed: 04/03/2023] Open
Abstract
Background More than 80% of elderly Americans have at least one chronic disease. While past studies have shown that hierarchical patterns of functional loss may differ by gender and institutional settings, little is known about whether such patterns differ in relation to chronic health condition. The aim of this study is to investigate the pattern of functional loss among older adults with major chronic illnesses, and to compare their onset and ordering of incident ADL disability with those of persons without such conditions. Methods We use a nationally representative sample of persons aged 80+ from the 1998–2014 Asset and Health Dynamics of the Oldest Old survey. The group with major noncommunicable diseases (including cardiovascular disease, cancer, chronic respiratory disease, and diabetes) comprises 3,514,052 subjects, while the comparison group comprises 1,073,263 subjects. Self-reports of having difficulty with six distinct ADLs are used to estimate disability incidence rate. Nonparametric statistical methods are used to derive median onset ages and ADL loss sequence separately for each group. Results Older adults with major chronic diseases have higher rates of incident disability across all ADL items. Estimated median onset ages of ADL disabilities for the full sample range from 91.5 to 95.6. Disability occurs earlier for chronically ill persons (onset ages 91.1–95.0) than for those in the comparison group (onset ages 93.5–98.1). Among those with major chronic diseases, the ADL loss sequence ordered by median ages of disability onset is bathing, walking, dressing, toileting, transferring and eating. The activities are also distinctly separated into an early-loss cluster and a late-loss cluster. Although the loss sequence derived for the comparison group is largely similar, disability progression for those with major chronic diseases is compressed within a shorter timeframe and the timing gaps between adjacent disabilities are smaller. Conclusions Older Americans with major noncommunicable diseases face an earlier and steeper slope of functional decline. Chronic care delivery programs should adapt to dynamic changes in older patients’ functional status. Health interventions to help patients delay disability onset and optimize functional autonomy within emerging models of chronic care should especially target early-loss activities such as bathing, dressing, and walking.
Collapse
Affiliation(s)
- Joelle H Fong
- National University of Singapore, 469C Bukit Timah Road, Singapore, 259771, Singapore.
| |
Collapse
|
27
|
Palese A, Grassetti L, Bressan V, Decaro A, Kasa T, Longobardi M, Hayter M, Watson R. A path analysis on the direct and indirect effects of the unit environment on eating dependence among cognitively impaired nursing home residents. BMC Health Serv Res 2019; 19:775. [PMID: 31666063 PMCID: PMC6822399 DOI: 10.1186/s12913-019-4667-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aims to estimate the direct and indirect effects of the unit environment alongside individual and nursing care variables on eating dependence among residents who are cognitively impaired and living in a nursing home. METHOD A multicentre observational study was carried out in 2017: 13 Italian nursing homes were involved in data collection. Included residents were aged > 65 at baseline, living in the considered facility for the last 6 months and during the entire study period and having received at least one comprehensive assessment. Data were collected (a) at the individual level: eating dependence using the Edinburgh Feeding Evaluation in Dementia Scale and other clinical variables; (b) at the nursing care level with daily interventions to maintain eating independence assessed with a checklist; and (c) at the nursing home level, using the Therapeutic Environment Screening Survey for Nursing Homes. RESULTS One thousand twenty-seven residents were included with an average age of 85.32 years old (95% CI: 84.74-85.89), mainly female (781; 76%). The path analysis explained the 57.7% variance in eating dependence. Factors preventing eating dependence were: (a) at the individual level, increased functional dependence measured with the Barthel Index (β - 2.374); eating in the dining room surrounded by residents (β - 1.802) as compared to eating alone in bed; and having a close relationship with family relatives (β - 0.854), (b) at the nursing care level, the increased number of interventions aimed at promoting independence (β - 0.524); and (c) at the NH level, high scores in 'Space setting' (β - 4.446), 'Safety' (β - 3.053), 'Lighting' (β - 2.848) and 'Outdoor access' (β - 1.225). However, environmental factors at the unit level were found to have also indirect effects by influencing the degree of functional dependence, the occurrence of night restlessness and the number of daily interventions performed by the nursing staff. CONCLUSION Eating dependence is a complex phenomenon requiring interventions targeting individual, nursing care, and environmental levels. The NH environment had the largest direct and indirect effect on residents' eating dependence, thus suggesting that at this level appropriate interventions should be designed and implemented.
Collapse
Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Luca Grassetti
- Department of Economics and Statistics, Udine University, Via Francesco Tomadini, 30, 33100 Udine, Italy
| | - Valentina Bressan
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Alessandro Decaro
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Tea Kasa
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Melania Longobardi
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Mark Hayter
- Faculty of Health Sciences, Hull University, Hull, HU6 7RX UK
| | - Roger Watson
- Faculty of Health Sciences, Hull University, Hull, HU6 7RX UK
| |
Collapse
|
28
|
Rahman MM, Byles JE. Older women's patterns of home and community care use and transition to residential aged care: An Australian cohort study. Maturitas 2019; 131:28-33. [PMID: 31787144 DOI: 10.1016/j.maturitas.2019.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/08/2019] [Accepted: 10/07/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine whether patterns of home and community care (HACC) use and person-based characteristics were associated with time to enter permanent residential aged care (RAC). STUDY DESIGN A prospective cohort study. The sample consisted of 8062 participants of the Australian Longitudinal Study on Women's Health who used HACC services between 2001 and 2014. MAIN OUTCOME MEASURES Time from first HACC use to enter permanent RAC. The median follow-up time was 63 months. Factors associated with time to enter RAC were identified using competing risk regression models. RESULTS Of the 8062 participants, 60% belonged to the 'basic HACC' group, who used few services minimally; 16% belonged to the 'moderate HACC' group, who predominantly used domestic assistance with moderate use of other services; and 24% belonged to the 'complex HACC' group, who used many services frequently. Being a member of the complex HACC group was associated with a lower cumulative incidence of RAC than basic or moderate HACC (chances 15% versus 30% by the median observation period, p < 0.01). Living in a remote/outer region (sub-distributional hazard ratio (sdHR) = 0.83, 95%CI: 0.74 - 0.93) was associated with delayed admission to RAC. Meanwhile, earlier admission was associated with living in an apartment (sdHR = 1.29, 95%CI: 1.20-1.40) or a retirement village (sdHR = 1.54, 95%CI = 1.38-1.72), having a physical functioning score <40 (sdHR = 1.16, 95%CI = 1.05-1.25), and falls with injury (sdHR = 1.15, 95%CI = 1.05-1.25). CONCLUSIONS Our findings highlight the importance of providing more community care services, age-friendly housing, falls prevention and physical activity programs to reduce inappropriate admission to RAC.
Collapse
Affiliation(s)
- Md Mijanur Rahman
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Australia; Department of Statistics, Comilla University, Bangladesh.
| | - Julie E Byles
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Australia
| |
Collapse
|
29
|
Rahman M, Efird JT, Kendig H, Byles JE. Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women's Health. Eur J Ageing 2019; 16:293-303. [PMID: 31543724 PMCID: PMC6728407 DOI: 10.1007/s10433-018-0495-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.
Collapse
Affiliation(s)
- Mijanur Rahman
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New Lambton Heights, NSW 2305 Australia
- Department of Statistics, Comilla University, Comilla, 3504 Bangladesh
| | - Jimmy T. Efird
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New Lambton Heights, NSW 2305 Australia
| | - Hal Kendig
- Research School of Population Health, Australian National University, Canberra, 0200 Australia
| | - Julie E. Byles
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, West Wing, Level 4, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, New Lambton Heights, NSW 2305 Australia
| |
Collapse
|
30
|
Chiriboga DA, Park NS, Gilbert K, Molinari VA, Barnes M. Cognitive and Functional Status of Persons Newly Enrolled at Dementia-Specific Adult Day Centers and Burden of Their Caregivers. Innov Aging 2019; 3:igz013. [PMID: 31263789 PMCID: PMC6592638 DOI: 10.1093/geroni/igz013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Recognizing the important role that dementia-specific adult day centers have in maintaining persons with a neurocognitive disorder in their home, this article examines three critical indicators at the time when people first enroll in such a center: cognitive and functional impairment of the enrollee, and burden reported by their family caregivers. We also considered variations in these 3 indicators by race/ethnicity and by the relationship of caregiver to the new enrollee. Research Design and Methods We conducted a secondary analysis of data collected by a nonprofit organization operating 11 dementia-specific adult day centers located on the east coast of Florida. Nursing staff conducted intake interviews with enrollees and their caregivers, and assessed functional status within one month of admission. Instruments included the Zarit Burden Scale and components of the Minimum Data Set: the Brief Interview for Mental Status (BIMS) and 4 measures of functional status. Results On average the cognitive scores of newly enrollees were well-within the range indicated for severe impairment, and these levels did not differ by race/ethnicity. Burden reported by caregivers however differed significantly, with Latinx caregivers reporting the greatest burden and African American/Black caregivers reporting the least. Further, while daughters generally reported higher levels of burden than other family caregivers, Black daughters reported the least. Discussion and Implications Results suggest a need for greater dissemination efforts about adult day programs to the Latinx community, as well as attention to the disparate burden placed upon differing family relationships of caregivers to enrollees.
Collapse
Affiliation(s)
- David A Chiriboga
- Department of Child & Family Studies, University of South Florida, Tampa
| | - Nan S Park
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Karen Gilbert
- Alzheimer's Community Care, West Palm Beach, Florida
| | - Victor A Molinari
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Mary Barnes
- Alzheimer's Community Care, West Palm Beach, Florida
| |
Collapse
|
31
|
Brown RT, Diaz-Ramirez LG, Boscardin WJ, Lee SJ, Williams BA, Steinman MA. Association of Functional Impairment in Middle Age With Hospitalization, Nursing Home Admission, and Death. JAMA Intern Med 2019; 179:668-675. [PMID: 30958504 PMCID: PMC6503566 DOI: 10.1001/jamainternmed.2019.0008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Difficulty performing daily activities such as bathing and dressing ("functional impairment") affects nearly 15% of middle-aged adults. Older adults who develop such difficulties, often because of frailty and other age-related conditions, are at increased risk of acute care use, nursing home admission, and death. However, it is unknown if functional impairments that develop among middle-aged people, which may have different antecedents, have similar prognostic significance. OBJECTIVE To determine whether middle-aged individuals who develop functional impairment are at increased risk for hospitalization, nursing home admission, and death. DESIGN, SETTING, AND PARTICIPANTS This matched cohort study analyzed longitudinal data from the Health and Retirement Study, a nationally representative prospective cohort study of US adults. The study population included 5540 adults aged 50 to 56 years who did not have functional impairment at study entry in 1992, 1998, or 2004. Participants were followed biennially through 2014. Individuals who developed functional impairment between 50 and 64 years were matched by age, sex, and survey wave with individuals without impairment as of that age and survey wave. Statistical analysis was conducted from March 15, 2017, to December 11, 2018. EXPOSURES Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, and impairment in instrumental ADLs (IADLs), defined similarly. MAIN OUTCOMES AND MEASURES The 3 primary outcomes were time from the first episode of functional impairment (or matched survey wave, in controls) to hospitalization, nursing home admission, and death. Follow-up assessments occurred every 2 years until 2014. Competing risks survival analysis was used to assess the association of functional impairment with hospitalization and nursing home admission and Cox proportional hazards regression analysis was used to assess the association with death. RESULTS Of the 5540 study participants (2739 women and 2801 men; median age, 53.7 years [interquartile range, 52.3-55.2 years]), 1097 (19.8%) developed ADL impairment between 50 and 64 years, and 857 (15.5%) developed IADL impairment. Individuals with ADL impairment had an increased risk of each adverse outcome compared with those without impairment, including hospitalization (subhazard ratio, 1.97; 95% CI, 1.77-2.19), nursing home admission (subhazard ratio, 2.62; 95% CI, 1.99-3.45), and death (hazard ratio, 2.06; 95% CI, 1.74-2.45). After multivariable adjustment, the risks of hospitalization (subhazard ratio, 1.54; 95% CI, 1.36-1.75) and nursing home admission (subhazard ratio, 1.73; 95% CI, 1.24-2.43) remained significantly higher among individuals with ADL impairment, but the risk of death was not statistically significant (hazard ratio, 1.06; 95% CI, 0.85-1.32). Individuals with IADL impairment had an increased risk of all 3 outcomes in adjusted and unadjusted analyses. CONCLUSIONS AND RELEVANCE Similar to older adults, middle-aged adults who develop functional impairment appear to be at increased risk for adverse outcomes. Even among relatively young people, functional impairment has important clinical implications.
Collapse
Affiliation(s)
- Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Geriatrics and Extended Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Statistical Editor
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Brie A Williams
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| |
Collapse
|
32
|
Coburn AF, Ziller EC, Paluso N, Thayer D, Talbot JA. Long-Term Services and Supports Use Among Older Medicare Beneficiaries in Rural and Urban Areas. Res Aging 2019; 41:241-264. [PMID: 30636556 DOI: 10.1177/0164027518824117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
State and federal policies have shifted long-term services and support (LTSS) priorities from nursing home care to home and community-based services (HCBS). It is not clear whether the rural LTSS system reflects this system transformation. Using the Medicare Current Beneficiary Survey, we examined nursing home use among rural and urban Medicare beneficiaries aged 65 and older. Study findings indicate that even after controlling for known predictors of nursing home use, rural Medicare beneficiaries exhibited greater odds of nursing home residence and that the higher odds of rural nursing home residence are, in part, associated with higher rural nursing home bed supplies. A complex interplay of policy, LTSS infrastructure, and social, cultural, and other factors may be influencing the observed differences. Federal and state efforts to build rural HCBS capacity may be necessary to mitigate stubbornly persistent rural-urban differences in the patterns of institutional and community-based LTSS use.
Collapse
Affiliation(s)
- Andrew F Coburn
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Erika C Ziller
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Nathan Paluso
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Deborah Thayer
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| | - Jean A Talbot
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA
| |
Collapse
|
33
|
McGrath R, Al Snih S, Markides K, Hackney K, Bailey R, Peterson M. The Burden of Functional Disabilities for Middle-Aged and Older Adults in the United States. J Nutr Health Aging 2019; 23:172-174. [PMID: 30697627 PMCID: PMC8262105 DOI: 10.1007/s12603-018-1133-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Understanding the role of functional capacity on longevity is important as the population in the United States ages. The purpose of this study was to determine the burden of instrumental activities of daily living (IADL) and activities of daily living (ADL) disabilities for a nationally-representative sample of middle-aged and older adults in the United States. DESIGN Longitudinal-Panel. SETTING Core interviews were often performed in person or over the telephone. PARTICIPANTS A sub-sample of 31,055 participants aged at least 50 years from the 1998-2014 waves of the Health and Retirement Study who reported having a functional disability were included. MEASUREMENTS Ability to perform IADLs and ADLs were self-reported at each wave. The National Death Index was used to ascertain date of death. The number of years of life that were lost (YLLs) and years lived with a disability (YLDs) were summed for the calculation of disability-adjusted life years (DALYs). Sampling weights were used in the analyses to make the DALYs nationally-representative. The results for YLLs, YLDs, and DALYs are reported in thousands. RESULTS Of the participants included, 14,990 had an IADL disability and 13,136 had an ADL disability. Men and women with an IADL disability had 236,037 and 233,772 DALYs, respectively; whereas, there were 178,594 DALYs for males and 253,630 DALYs for females with an ADL disability. Collectively, there were 469,809 years of healthy life lost from IADL impairments, and 432,224 years of healthy life lost from ADL limitations. CONCLUSIONS These findings should be used to inform healthcare providers and guide interventions aiming to preserve the functional capacity of aging adults. Prioritizing health-related resources for mitigating the burden of functional disabilities may help aging adults increase their quality of life and life expectancy over time.
Collapse
Affiliation(s)
- R McGrath
- Ryan McGrath, PhD, North Dakota State University, NDSU Dept. 2620, PO Box 6050, Fargo, ND 58108-6050,
| | | | | | | | | | | |
Collapse
|
34
|
Untapped Potential: Using the HRS-Medicare-Linked Files to Study the Changing Nursing Home Population. Med Care 2018; 56:216-219. [PMID: 29298176 DOI: 10.1097/mlr.0000000000000866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nursing home (NH) care in the United States now includes many short-term admissions to skilled nursing facilities (SNFs) for postacute care. OBJECTIVE To demonstrate the potential of the Health and Retirement Study (HRS) linked to administrative data to study this group. RESEARCH DESIGN Descriptive retrospective panel study. SUBJECTS HRS respondents between 2002 and 2010 linked to administrative data from the Centers for Medicare and Medicaid Services (CMS). MEASURES NH use was defined in 3 ways: by survey responses, Medicare SNF claims, and mandatory NH assessments. RESULTS In total, 8.5% of observation periods (ie, time between 2 consecutive survey dates or 2 years before initial survey) reported by the survey and 26.0% reported by administrative data indicated some NH use. There was 98% agreement between survey responses and administrative data when there was no indication of a NH observation in the administrative data. However, there was only 33% agreement between survey responses and administrative data when a NH stay was indicated in the administrative data. NH stays associated with SNF care were responsible for the discrepancy-they were not consistently captured by the HRS survey. Rates of agreement were highest when a proxy respondent was used, and lowest among respondents who rated themselves in excellent overall health. Rates of agreement were higher later in the decade than earlier. CONCLUSIONS The HRS-Medicare-linked files enhance the ability of the HRS to examine the growing use of NH for postacute care as well as offer a more comprehensive view of who uses NHs.
Collapse
|
35
|
MCGRATH RYANP, VINCENT BRENDAM, LEE IMIN, KRAEMER WILLIAMJ, PETERSON MARKD. Handgrip Strength, Function, and Mortality in Older Adults: A Time-varying Approach. Med Sci Sports Exerc 2018; 50:2259-2266. [DOI: 10.1249/mss.0000000000001683] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Wolff JL, Mulcahy J, Roth DL, Cenzer IS, Kasper JD, Huang J, Covinsky KE. Long-Term Nursing Home Entry: A Prognostic Model for Older Adults with a Family or Unpaid Caregiver. J Am Geriatr Soc 2018; 66:1887-1894. [PMID: 30094823 PMCID: PMC6181771 DOI: 10.1111/jgs.15447] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To comprehensively examine factors associated with long-term nursing home (NH) entry from 6 domains of older adult and family caregiver risk from nationally representative surveys and develop a prognostic model and a simple scoring system for use in risk stratification. DESIGN Retrospective observational study. SETTING National Long-Term Care Surveys 1999 and 2004 and National Health and Aging Trends Study 2011 and linked caregiver surveys. PARTICIPANTS Community-living older adults receiving help with self-care disability and their primary family or unpaid caregiver (N=2,676). MEASUREMENTS Prediction of long-term NH entry (>100 days or ending in death) by 24 months follow up, ascertained from Minimum Data Set assessments and dates of death from Medicare enrollment files. Risk factors were measured from survey responses. RESULTS In total, 16.1% of older adults entered a NH. Our final model and risk scoring system includes 7 independent risk factors: older adult age (1 point/5 years), living alone (5 points), dementia (3 points), 3 or more of 6 self-care activities (2 points), caregiver age (45-64: 1 point, 65-74: 2 points, ≥75: 4 points), caregiver help with money management (2 points), and caregiver report of moderate (2 points) or high (4 points) strain. Using this model, participants were assigned to risk quintiles. Long-term NH entry was 7.0% in the lowest quintile (0-6 points), 20.4% in the middle 3 quintiles (7-14 points), and 30.9% in the highest quintile (15-22 points). The model was well calibrated and demonstrated moderate discrimination (c-statistic=0.670 in the original data, c-statistic=0.647 in bootstrapped samples, c-statistic=0.652 using the point-scoring system). CONCLUSION We developed a prognostic model and simple scoring system that may be used to stratify risk of long-term NH entry of community-living older adults. Our model may be useful for population health and policy applications.
Collapse
Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Bloomberg School of Public Health
| | - John Mulcahy
- Department of Health Policy and Management, Bloomberg School of Public Health
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Irena S Cenzer
- Division of Geriatric Medicine, University of California, San Francisco, San Francisco, California
| | - Judith D Kasper
- Department of Health Policy and Management, Bloomberg School of Public Health
| | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kenneth E Covinsky
- Division of Geriatric Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
37
|
Patient-Reported Outcomes in Functioning Following Nursing Home or Inpatient Rehabilitation. J Am Med Dir Assoc 2018; 19:864-870. [PMID: 30056009 DOI: 10.1016/j.jamda.2018.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our study examines factors associated with patient-reported outcomes in functioning among Medicare beneficiaries who reported receiving rehabilitation services in a nursing home or inpatient (ie, hospital or rehabilitation facility) setting in the prior year. DESIGN Data are from the 2015 and 2016 rounds of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING AND PARTICIPANTS A total of 479 participants in the 2016 sample who reported receiving rehabilitation services in a nursing home or inpatient setting in the past year. MEASURES Bivariate and logistic regression analyses examined the association of demographic, socioeconomic status, and health variables (from the 2015 interview) and rehabilitation characteristics (from the 2016 interview) with patient-reported improvement in "functioning and ability to do activities" while receiving rehabilitation services in the past year. RESULTS Among Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings, 33.4% (weighted percent) reported no improvement in functioning while they were receiving rehabilitation. In a regression analysis that accounted for demographics, those with a high school education or less (compared with those with a college degree), instrumental activities of daily living impairments, certain primary conditions for rehabilitation, less than 1-month total duration of rehabilitation services, and no outpatient rehabilitation services had greater odds of reporting no improvement. CONCLUSIONS/IMPLICATIONS Our weighted sample represents approximately 2.3 million Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings. In this sample, 1 in 3 reported no improvement in functioning, with differences in patient-reported outcomes across socioeconomic status, health status, and rehabilitation characteristics domains. Consideration of characteristics across these domains may be clinically pertinent, but investigation as to why these differences are present and whether services can be optimized to further improve patient-reported outcomes is warranted.
Collapse
|
38
|
Palese A, Grassetti L, Bandera D, Zuttion R, Ferrario B, Ponta S, Hayter M, Watson R. High feeding dependence prevalence in residents living in Italian nursing homes requires new policies: Findings from a regionally based cross-sectional study. Health Policy 2018; 122:301-308. [PMID: 29409682 DOI: 10.1016/j.healthpol.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 01/05/2018] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES An increased amount of functional dependence has been reported among residents living in nursing homes. Among others, feeding dependence is one of the most complex needs to satisfy: behind the attempt to personalise meals with individual preferences and clinical regimens, all residents require help at the same moment and for long periods of time, three or more times a day. With the intent of debating policy implications, the aims of this study were to advance the knowledge in the field of feeding dependence prevalence and predictors in Italy, a country where life expectancy is among the highest in the World. METHOD A large retrospective regionally-based study approaching all nursing homes (n = 105) was performed in 2014; all residents (n = 10,900) were eligible and those with a completed assessment recorded in the regional database and aged >65 years (n = 8875) were included. RESULTS 1839 residents (20.7%) were in total need of help in feeding on a daily basis. At the multilevel analysis, predictors were moderate/severe dementia (OR 4.044, CI 95% 3.213-5.090); dysphagia (OR 4.003 CI 95% 3.155-5.079); pressure sores (OR 2.317 CI 95% 1.803-2.978); unintentional weigh loss (OR 2.197 CI 95% 1.493-3.233); unsociability (OR 1.561 CI 95% 1.060-2.299); and clinical instability (OR 1.363 CI 95% 1.109-1.677). CONCLUSIONS The feeding dependence prevalence emerged seem to be unique compared to that documented at the international levels. Modifiable and unmodifiable predictors found require new policies regarding workforce skills-mix and shifts schedules; as well as alliances with families, associations and communities' stakeholders. According to the complexity of the resident profile emerged, staff education and training is also recommended.
Collapse
Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, Udine University, Italy.
| | - Luca Grassetti
- Department of Economics and Statistics, Udine University, Italy
| | | | | | | | - Sandra Ponta
- Welfare Unit, Friuli Venezia Giulia Region, Italy
| | - Mark Hayter
- Faculty of Health Siences, Hull University, UK
| | | |
Collapse
|
39
|
Fong JH, Feng J. Comparing the loss of functional independence of older adults in the U.S. and China. Arch Gerontol Geriatr 2018; 74:123-127. [DOI: 10.1016/j.archger.2017.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
|
40
|
"We don't have the infrastructure to support them at home": How health system inadequacies impact on long-term care admissions of people with dementia. Health Policy 2017; 121:1280-1287. [PMID: 29031934 DOI: 10.1016/j.healthpol.2017.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The influence of healthcare system factors on long-term care admissions has received relatively little attention. We address this by examining how inadequacies in the healthcare system impact on long-term care admissions of people with dementia. This is done in the context of the Irish healthcare system. METHODS Thirty-eight qualitative in-depth interviews with healthcare professionals and family carers were conducted. Interviews focused on participants' perceptions of the main factors which influence admission to long-term care. Interviews were analysed thematically. RESULTS The findings suggest that long-term care admissions of people with dementia may be affected by inadequacies in the healthcare system in three ways. Firstly, participants regarded the economic crisis in Ireland to have exacerbated the under-resourcing of community care services. These services were also reported to be inequitable. Consequently, the effectiveness of community care was seen to be limited. Secondly, such limits in community care appear to increase acute hospital admissions. Finally, admission of people with dementia to acute hospitals was believed to accelerate the journey towards long-term care. CONCLUSIONS Inadequacies in the healthcare system are reported to have a substantial impact on the threshold for long-term care admissions. The findings indicate that we cannot fully understand the factors that predict long-term care admission of people with dementia without accounting for healthcare system factors on the continuation of homecare.
Collapse
|
41
|
The Association Between Activity Limitation Stages and Admission to Facilities Providing Long-term Care Among Older Medicare Beneficiaries. Am J Phys Med Rehabil 2017. [PMID: 28628533 DOI: 10.1097/phm.0000000000000653] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to examine whether activity limitation stages are associated with admission to facilities providing long-term care (LTC). DESIGN Cohort study using Medicare Current Beneficiary Survey data from the 2005-2009 entry panels. A total of 14,580 community-dwelling Medicare beneficiaries 65 years or older were included. Proportional subhazard models examined associations between activity limitation stages and time to first LTC admission, adjusting for baseline sociodemographics and health conditions. RESULTS The weighted annual rate of LTC admission was 1.1%. In the adjusted model, compared to activity of daily living (ADL) stage 0, the hazard ratios (95% confidence intervals [CIs]) were 2.0 (1.5-2.7), 3.9 (2.9-5.4), 3.6 (2.5-5.3), and 4.7 (2.5-9.0) for ADL stage I (mild limitation), ADL stage II (moderate limitation), ADL stage III (severe limitation), and ADL stage IV (complete limitation), respectively. Compared to instrumental ADL (IADL) stage 0, the hazard ratios, and 95% CIs for IADL stages I to IV were 2.0 (1.4-2.7), 3.7 (2.6-5.4), 4.6 (3.3-6.5), and 7.6 (4.6-12.3), respectively. CONCLUSIONS Activity limitation stages are strongly associated with future admission to LTC and may therefore be useful in identifying specific supportive care needs among vulnerable older community-dwelling adults, which may reduce or the delay need for admission to LTC.
Collapse
|
42
|
Predicting long-term nursing home transfer from MI choice waiver program. Geriatr Nurs 2016; 37:446-452. [DOI: 10.1016/j.gerinurse.2016.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
|
43
|
Liu SK, Montgomery J, Yan Y, Mecchella JN, Bartels SJ, Masutani R, Batsis JA. Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults. J Am Geriatr Soc 2016; 64:2095-2100. [PMID: 27602551 PMCID: PMC5073021 DOI: 10.1111/jgs.14345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization. DESIGN Retrospective cohort study. SETTING Inpatient unit of a rural academic medical center. PARTICIPANTS Hospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014. MEASUREMENTS Participant age at the time of admission, modified Folstein Mini-Mental State Examination score, and self-reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay. RESULTS Four hundred twenty-eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) (P < .001). After adjustment, participants with high HARP scores were more than four times as likely as those with low scores to be discharged to a facility (odds ratio = 4.58, 95% confidence interval = 2.42-8.66). CONCLUSION In a population of older hospitalized adults, HARP score (using readily available admission information) identifies individuals at greater risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning.
Collapse
Affiliation(s)
- Stephen K Liu
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Justin Montgomery
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Yu Yan
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - John N Mecchella
- Section of Rheumatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Stephen J Bartels
- Department of Psychiatry, Dartmouth College, Hanover, New Hampshire
- Dartmouth Institute for Health Policy and Clinical Practice, Centers for Health and Aging, Dartmouth College, Lebanon, New Hampshire
| | - Rebecca Masutani
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
44
|
Fong JH, Feng J. Patterns of Functional Disability in the Oldest Adults in China. J Am Geriatr Soc 2016; 64:1890-4. [DOI: 10.1111/jgs.14264] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joelle H. Fong
- SIM University; Singapore Singapore
- Australian Research Council Centre of Excellence in Population Ageing Research; University of New South Wales; Sydney New South Wales Australia
| | - Jun Feng
- Monash-Commonwealth Scientific and Industrial Research Organisation Superannuation Research Cluster; Monash University; Clayton Victoria Australia
| |
Collapse
|
45
|
Mlinac ME, Feng MC. Assessment of Activities of Daily Living, Self-Care, and Independence. Arch Clin Neuropsychol 2016; 31:506-16. [PMID: 27475282 DOI: 10.1093/arclin/acw049] [Citation(s) in RCA: 384] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/15/2022] Open
Abstract
Activities of daily living (ADL) comprise the basic actions that involve caring for one's self and body, including personal care, mobility, and eating. In this review article, we (1) review useful clinical tools including a discussion on ways to approach ADL assessment across settings, (2) highlight relevant literature evaluating the relationship between cognitive functioning and ADLs, (3) discuss other biopsychosocial factors affecting ADL performance, (4) provide clinical recommendations for enhancing ADL capacity with an emphasis on self-care tasks (eating, grooming, dressing, bathing and toileting), and (5) identify interventions that treatment providers can implement to reduce the burden of ADL care.
Collapse
Affiliation(s)
- Michelle E Mlinac
- VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
46
|
Ihl R, Cujai N, Krah K. Admission into a Nursing Home. Delay or prevention with the use of a complete support network? Z Gerontol Geriatr 2016; 49:196-200. [PMID: 27041696 DOI: 10.1007/s00391-016-1045-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/02/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Becoming older in Germany often leads to admission into a nursing home. OBJECTIVE The aim of this study was to investigate if a complete support network (CSN) can contribute to preventing admission into a nursing home. Organizational and financial prerequisites of a CSN were documented. MATERIAL AND METHODS In this study 32 patients with psychiatric disorders diagnosed according to the International Classification of Diseases 10 (ICD 10, 16 as F00 dementia in Alzheimer disease and 16 as F31-33 bipolar affective disorder, depressive episode and recurrent depressive disorder) were observed over a period of 2 years. The intervention consisted of participation in a defined CSN, which was developed by the Alexian Research Centre in Krefeld (ARCK). A cooperation of all persons and institutions involved in the care of elderly patients with psychiatric disorders was initiated. An individualized help plan was compiled for each patient. The primary outcome was admittance to a nursing home or remaining at home. The duration of staying at home was measured in days. User satisfaction was assessed with a 5‑step Likert scale questionnaire. The steering process and the financial efforts necessary to run the CSN were descriptively evaluated. RESULTS At the end of the observation period 28 out of 32 patients were not admitted to a nursing home. During the observational period one patient dropped out, one died and two were admitted to a nursing home. User satisfaction achieved a median score of 5 (very satisfied). No additional funding was necessary to run the CSN. CONCLUSION The CSN can prevent admission to a nursing home without needing additional funding and the whole process can be guided by the patient.
Collapse
Affiliation(s)
- Ralf Ihl
- Department of Psychiatry, University of Duesseldorf, Duesseldorf, Germany.
- Alexian Research Center, Dießemer Bruch 81, 47805, Krefeld, Germany.
| | - Nadine Cujai
- Alexian Research Center, Dießemer Bruch 81, 47805, Krefeld, Germany
| | - Katrin Krah
- Alexian Research Center, Dießemer Bruch 81, 47805, Krefeld, Germany
| |
Collapse
|
47
|
Assessing the Functional Status of Older Cancer Patients in an Ambulatory Care Visit. Healthcare (Basel) 2015; 3:846-59. [PMID: 27417801 PMCID: PMC4939579 DOI: 10.3390/healthcare3030846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/26/2015] [Accepted: 09/10/2015] [Indexed: 01/22/2023] Open
Abstract
Functional status assessment is a useful and essential component of the complete history and physical exam of the older patient diagnosed with cancer. Functional status is the ability to conduct activities that are necessary for independence and more executive activities, such as money management, cooking, and transportation. Assessment of functional status creates a portal into interpreting the health of in older persons. Understanding limitations and physical abilities can help in developing cancer treatment strategies, patient/family teaching needs, and in-home services that enhance patient/family care. This article will review the benefits of functional assessment, instruments that can be used during an ambulatory care visit, and interventions that can address potential limitations.
Collapse
|