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Barrio-Cortes J, Castaño-Reguillo A, Benito-Sánchez B, Beca-Martínez MT, Ruiz-Zaldibar C. Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid). Healthcare (Basel) 2024; 12:270. [PMID: 38275550 PMCID: PMC10815081 DOI: 10.3390/healthcare12020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.
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Affiliation(s)
- Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
- Faculty of Health, Camilo José Cela University, 28692 Madrid, Spain
| | | | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
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Goes M, Oliveira H, Lopes M, Fonseca C, Pinho L, Marques M. A nursing care-sensitive patient satisfaction measure in older patients. Sci Rep 2023; 13:7607. [PMID: 37165074 PMCID: PMC10172317 DOI: 10.1038/s41598-023-33805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
As a novelty, this article proposes the empirical operationalization of an indicator sensitive to nursing care called patient satisfaction based on functional capacity and quality of life assessments. This was a descriptive cross-sectional study with a sample of 351 individuals aged 65 and older residing in the community. Data acquisition was performed using the structured interview method, employing a core set of 25 codes taken from the International Classification of Functioning, Disability, and Health and the WHOQOL-BREF instrument of the World Health Organization. Confirmatory factor analysis was used to infer the reliability and construct validity of the proposed model, involving three latent factors: functional capacity, quality of life, and patient satisfaction with nursing care received. The proposed model showed good reliability and construct validity, although it failed regarding discriminant validity between latent factors. The greatest statistically significant predictor of the patient satisfaction latent factor was the quality of life latent factor ([Formula: see text]), followed by the functional capacity latent factor ([Formula: see text]). The findings seem to suggest that patient satisfaction is an indicator that may be quantitatively measurable, with functional capacity and quality of life considered very significant predictors of patient satisfaction with the nursing care experience.
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Affiliation(s)
- Margarida Goes
- Comprehensive Health Research Center, Universidade de Évora, Évora, Portugal
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Évora, Portugal
| | - Henrique Oliveira
- Instituto de Telecomunicações, Aveiro, Portugal.
- Instituto Politécnico de Beja, Beja, Portugal.
| | - Manuel Lopes
- Comprehensive Health Research Center, Universidade de Évora, Évora, Portugal
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Évora, Portugal
| | - César Fonseca
- Comprehensive Health Research Center, Universidade de Évora, Évora, Portugal
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Évora, Portugal
| | - Lara Pinho
- Comprehensive Health Research Center, Universidade de Évora, Évora, Portugal
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Évora, Portugal
| | - Maria Marques
- Comprehensive Health Research Center, Universidade de Évora, Évora, Portugal
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Évora, Portugal
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Brown MT, Mutambudzi M. Psychiatric history and later-life cognitive change: effect modification by sex, race and ethnicity. Aging Ment Health 2022:1-8. [PMID: 36016466 DOI: 10.1080/13607863.2022.2116398] [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] [Indexed: 11/01/2022]
Abstract
Objective: We explored associations between psychiatric history and cognitive functioning, and differences by sex and race/ethnicity (SRE) in 20,155 Health and Retirement Study (1995-2014) participants aged 65 or older.Methods: Multi-level growth curve models examined cognition scores and their trajectories over time by SRE.Results: A history of psychiatric, emotional, or nervous problems was significantly related to cognition scores and rates of decline. Hispanic and Black participants had significantly lower cognition scores at age 75 and steeper rates of decline than White females, and Black race and the Hispanic race/ethnicity-sex interaction erased the protective effects of being female.Conclusions: Future research should include specific psychiatric diagnoses. Population level findings as reported here, along with aggregate findings from similar studies, can inform interventions and policies regarding support for populations that are vulnerable to mental illness and to subsequent cognitive decline.
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Affiliation(s)
- Maria T Brown
- School of Social Work and Aging Studies Institute, Syracuse University, Syracuse, NY, USA
| | - Miriam Mutambudzi
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, USA
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Ramos A, Fonseca C, Pinho L, Lopes M, Oliveira H, Henriques A. Functional Profile of Older Adults Hospitalized in Convalescence Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study. J Pers Med 2021; 11:jpm11121350. [PMID: 34945822 PMCID: PMC8704872 DOI: 10.3390/jpm11121350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Aim: To evaluate the evolution of the functional profile of older adults admitted to a health unit in Portugal; to relate the functional profile of these individuals with age, sex, education level and emotional state; and to evaluate the probability of the degree of dependence as a function of age and sex. Methods: longitudinal, retrospective study with a sample of 59,013 older adults admitted to convalescence units of the National Network of Integrated Continuous Care of Portugal. Results: In the first 75 days of hospitalization, activities of daily living, mobility and cognitive state improved, but there was a decline after 75 days of hospitalization. The ability to perform instrumental activities of daily living improved in the first 15 days of hospitalization, stabilized until 45 days and then began to worsen. Women had a higher probability of having a severe/complete dependence three years earlier than men (88 years to 91 years). A higher education level and stable emotional state were protective factors against functional decline. Conclusions: The functional profile of older adults improved during the length of stay recommended for hospitalization in convalescence units (30 days). It is critical for health systems to adopt strategies to prevent declines in the emotional state of frail individuals.
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Affiliation(s)
- Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal; (A.R.); (A.H.)
| | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
| | - Lara Pinho
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
- Correspondence:
| | - Manuel Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Evora, Portugal; (C.F.); (M.L.)
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Evora, Portugal
| | | | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal; (A.R.); (A.H.)
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
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Girwar SM, Jabroer R, Fiocco M, Sutch SP, Numans ME, Bruijnzeels MA. A systematic review of risk stratification tools internationally used in primary care settings. Health Sci Rep 2021; 4:e329. [PMID: 34322601 PMCID: PMC8299990 DOI: 10.1002/hsr2.329] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND AIMS In our current healthcare situation, burden on healthcare services is increasing, with higher costs and increased utilization. Structured population health management has been developed as an approach to balance quality with increasing costs. This approach identifies sub-populations with comparable health risks, to tailor interventions for those that will benefit the most. Worldwide, the use of routine healthcare data extracted from electronic health registries for risk stratification approaches is increasing. Different risk stratification tools are used on different levels of the healthcare continuum. In this systematic literature review, we aimed to explore which tools are used in primary healthcare settings and assess their performance. METHODS We performed a systematic literature review of studies applying risk stratification tools with health outcomes in primary care populations. Studies in Organisation for Economic Co-operation and Development countries published in English-language journals were included. Search engines were utilized with keywords, for example, "primary care," "risk stratification," and "model." Risk stratification tools were compared based on different measures: area under the curve (AUC) and C-statistics for dichotomous outcomes and R 2 for continuous outcomes. RESULTS The search provided 4718 articles. Specific election criteria such as primary care populations, generic health utilization outcomes, and routinely collected data sources identified 61 articles, reporting on 31 different models. The three most frequently applied models were the Adjusted Clinical Groups (ACG, n = 23), the Charlson Comorbidity Index (CCI, n = 19), and the Hierarchical Condition Categories (HCC, n = 7). Most AUC and C-statistic values were above 0.7, with ACG showing slightly improved scores compared with the CCI and HCC (typically between 0.6 and 0.7). CONCLUSION Based on statistical performance, the validity of the ACG was the highest, followed by the CCI and the HCC. The ACG also appeared to be the most flexible, with the use of different international coding systems and measuring a wider variety of health outcomes.
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Affiliation(s)
- Shelley‐Ann M. Girwar
- Department of Public Health and Primary Care, LUMC Campus the HagueLeiden University Medical CentreThe HagueThe Netherlands
- Jan van Es InstituutEdeThe Netherlands
| | - Robert Jabroer
- Department of Public Health and Primary Care, LUMC Campus the HagueLeiden University Medical CentreThe HagueThe Netherlands
| | - Marta Fiocco
- Mathematical InstituteLeiden UniversityLeidenThe Netherlands
- Medical Statistics Department of Biomedical Data ScienceLeiden University Medical CenterLeidenThe Netherlands
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Stephen P. Sutch
- Department of Public Health and Primary Care, LUMC Campus the HagueLeiden University Medical CentreThe HagueThe Netherlands
- Department of Health Policy and ManagementBloomberg School of Public Health Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Mattijs E. Numans
- Department of Public Health and Primary Care, LUMC Campus the HagueLeiden University Medical CentreThe HagueThe Netherlands
| | - Marc A. Bruijnzeels
- Department of Public Health and Primary Care, LUMC Campus the HagueLeiden University Medical CentreThe HagueThe Netherlands
- Jan van Es InstituutEdeThe Netherlands
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Abstract
Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient's aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient's function and quality of life at a time in life when these often become foremost therapeutic priorities.
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Affiliation(s)
| | - Daniel E Forman
- University of Pittsburgh, University of Pittsburgh Medical Center and VA Pittsburgh Geriatric, Research, Education and Clinical Center (GRECC), Pittsburgh, PA, USA
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Lopes MJ, de Pinho LG, Fonseca C, Goes M, Oliveira H, Garcia-Alonso J, Afonso A. Functioning and Cognition of Portuguese Older Adults Attending in Residential Homes and Day Centers: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137030. [PMID: 34209339 PMCID: PMC8297339 DOI: 10.3390/ijerph18137030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022]
Abstract
The functioning and cognition of older adults can be influenced by different care contexts. We aimed to compare the functioning profiles and cognition of institutionalized and noninstitutionalized older adults and to evaluate the effect of sociodemographic factors on the functioning and cognition. This is a cross-sectional study that included 593 older adults. The data were collected using the Elderly Nursing Core Set and Mini Mental State Examination. Women, older adults who did not attend school and those live in Residential Homes are more likely to have a higher degree of cognitive impairment than men, those who attended school and those frequent Day Centre. The chances of an older adult with moderate or severe cognitive impairment increases with age. Older women, older adults who did not attend school, and older adults who live in Residential Homes had a higher degree of functional problem than men, those who attended school and those who frequent a Day Centre, independently to age. It is necessary to promote the health literacy of older adults throughout life. The implementation of social and health responses should allow older adults to remain in their homes, given the influence of functioning and cognition on self-care and quality of life.
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Affiliation(s)
- Manuel José Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Correspondence: (M.J.L.); (L.G.d.P.); Tel.: +351-266-730-300
| | - Lara Guedes de Pinho
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Correspondence: (M.J.L.); (L.G.d.P.); Tel.: +351-266-730-300
| | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
| | - Margarida Goes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Escola Superior de Saúde, Instituto Politécnico de Beja, 7800-111 Beja, Portugal
| | - Henrique Oliveira
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Escola Superior de Saúde, Instituto Politécnico de Beja, 7800-111 Beja, Portugal
- Instituto de Telecomunicações, 1049-001 Lisboa, Portugal
| | - José Garcia-Alonso
- Department of Computer Systems and Telematics Engineering, University of Extremadura, 10003 Cáceres, Spain;
| | - Anabela Afonso
- Departamento de Matemática, Escola de Ciências e Tecnologia, Universidade de Évora, 7000-671 Évora, Portugal;
- Centro de Investigação em Matemática e Aplicações, Universidade de Évora, 7000-671 Évora, Portugal
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The Contribution of Case Mix, Skill Mix and Care Processes to the Outcomes of Community Hospitals: A Population-Based Observational Study. Int J Integr Care 2021; 21:25. [PMID: 34220389 PMCID: PMC8231454 DOI: 10.5334/ijic.5566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Community hospitals (CHs) could address the emerging complex care needs of patients. We investigated which characteristics of patients’ and CHs affect patient outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver this care. Methods: We analysed all elderly patients discharged from the CHs of Emilia-Romagna, Italy. CH skill mix and care processes were collected with an ad hoc survey. The primary outcome was improvement in the Barthel index (BI) on discharge. Hierarchical regression analysis was performed to test the associations under study. Results: 53% of the patients had a BI improvement ≥10. After adjusting for the diverse case mix of the patients, no significant association was found between CH characteristics and BI improvement. Patient characteristics explained only a portion of the variability in CH performance. Discussion: Heterogeneity in case mix reflects the nature of CHs, which play context-specific roles as integrators between primary care services and hospitals. Residual variability in BI improvement rates across CHs might be attributed to aspects of care not detected in our survey. Conclusions: More research is needed to study the impact of CH skill mix and care processes on patient outcomes.
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Huang CH, Hsu CC, Yu PC, Peng LN, Lin MH, Chen LK. Hospitalization-associated muscle weakness and functional outcomes among oldest old patients: A hospital-based cohort study. Exp Gerontol 2021; 150:111353. [PMID: 33892132 DOI: 10.1016/j.exger.2021.111353] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
AIM To investigate the prognostic significance of hospitalization-associated muscle weakness for short-term and long-term functional declines among oldest old hospitalized patients. METHODS We conducted a retrospective cohort study in the Geriatric Evaluation and Management Unit (GEMU) of a tertiary medical center in Taiwan. Data from patients admitted to the GEMU were collected, including demographic characteristics, underlying diseases, functional assessments, and nutritional status. Handgrip strength was measured at admission and before discharge, and hospitalization-associated muscle weakness was defined accordingly. Functional status was ascertained by a telephone survey, and functional decline was defined based on a comparison with each patient's functional status before discharge. RESULTS Overall, data from 555 patients were retrieved, and 431 patients (mean age: 86.0 ± 6.2 years, 78.5% males) were included in the study, with a mean Barthel Index score of 74.7 ± 20.8, Mini-Mental State Examination (MMSE) score of 19.1 ± 6.8, Geriatric Depression Scale (GDS-5) score of 2.2 ± 1.6, Mini-Nutritional Assessment-Short Form (MNA-SF) score of 8.9 ± 3.0, Cumulative Illness Rating Scale-Geriatric (CIRS-G) score of 2.2 ± 0.9, and the regular use of 6.7 ± 3.5 medications. Patients with a 1-month postdischarge functional decline had significantly lower body weight and body mass index, more severe frailty and more hospitalization-associated muscle weakness. Patients with a 6-month postdischarge functional decline had lower body weight, BMI, MMSE scores, MNA-SF scores, handgrip strength, Barthel Index scores, and Braden Scale scores. BMI (OR: 0.815, 95% CI: 0.691-0.962, P = 0.015) and hospitalization-associated muscle weakness (OR: 1.227, 95% CI: 1.147-1.332, P < 0.001) were significantly associated with a 1-month postdischarge functional decline. Hospitalization-associated muscle weakness (OR: 1.067, 95% CI: 1.035-1.101, P < 0.001), the risk of pressure sores (Braden Scale, OR: 0.767, 95% CI: 0.646-0.910, P = 0.002), and BMI (OR: 0.914, 95% CI: 0.838-0.998, P = 0.045) were independently associated with a 6-month postdischarge functional decline. CONCLUSIONS Hospitalization-associated muscle weakness significantly predicts functional decline among oldest old patients hospitalized for acute conditions. Further interventional studies are needed to examine the causal relationship between hospitalization-associated muscle weakness and clinical outcomes.
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Affiliation(s)
- Chieh-Han Huang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chia Hsu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Pei-Chin Yu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Neuroscience, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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10
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Machón M, Mateo-Abad M, Clerencia-Sierra M, Güell C, Poblador-Pou B, Vrotsou K, Gimeno-Miguel A, Prados-Torres A, Vergara I. Multimorbidity and functional status in older people: a cluster analysis. Eur Geriatr Med 2020; 11:321-332. [DOI: 10.1007/s41999-020-00291-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
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Goes M, Lopes MJ, Oliveira H, Fonseca C, Marôco J. A Nursing Care Intervention Model for Elderly People to Ascertain General Profiles of Functionality and Self Care Needs. Sci Rep 2020; 10:1770. [PMID: 32019984 PMCID: PMC7000781 DOI: 10.1038/s41598-020-58596-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/15/2020] [Indexed: 11/09/2022] Open
Abstract
A core set of International Classification of Functioning, Disability and Health codes was used to ascertain general profiles of functionality as a function of biological and sociodemographic characteristics and to develop structured nursing interventions in accordance with self care deficits identified by studying self care behavior for elderly people living in both extensively and sparsely populated rural areas. Data were collected by health professionals in the participants' houses. An exploratory factor analysis enabled reduced data dimensions, and factorial validity was assessed by a confirmatory factor analysis. An ordinal regression model was built to identify general profiles of functionality as a function of age. A bar graph was used as a measurement tool for nursing care needs as a function of self care behavior and functional profile level. No functional problems were expected among people under the age of 74 years, while mild functionality problems were expected among people older than 74 years. Regarding nursing care needs, the results of the constructed model suggested that the functional concept "Support and Relationships" is associated with higher levels of functional problems and thus a greater need for self care interventions and that people aged 85 years and older always show therapeutic self care deficits.
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Affiliation(s)
- Margarida Goes
- Escola Superior de Saúde, Instituto Politécnico de Beja, Beja, Portugal
| | - Manuel José Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal
| | | | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Évora, Portugal
| | - João Marôco
- ISPA - Instituto Universitário de Ciências Psicológicas Sociais e da Vida, Lisbon, Portugal
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12
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Gabbard J, Pajewski NM, Callahan KE, Dharod A, Foley K, Ferris K, Moses A, Grey C, Williamson J. Advance care planning for vulnerable older adults within an Accountable Care Organization: study protocol for the IMPACT randomised controlled trial. BMJ Open 2019; 9:e032732. [PMID: 31843844 PMCID: PMC6924763 DOI: 10.1136/bmjopen-2019-032732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Patients with multimorbidity plus additional impairments (eg, mobility limitations, disability, cognitive impairments or frailty) are at the highest risk for poor healthcare outcomes. Advanced care planning (ACP) provides patients and their surrogates the opportunity to discuss their goals, values and priorities for healthcare-particularly in the context of end-of-life care. ACP discussions promote more person-centred care; however, it is currently underused. There is a tremendous need for systematic, scalable approaches to individualised ACP that promotes patient and family engagement. Here we describe the study protocol for a randomised effectiveness trial of a nurse navigator and informatics intervention designed to improve the documentation and quality of ACP discussions. METHODS AND ANALYSIS This is a randomised, pragmatic, effectiveness trial; patients aged 65 years and older who have multimorbidity plus impairments in either physical function (eg, mobility limitations or disability) or cognition, and/or frailty within an affiliated Accountable Care Organization were eligible. The electronic health record was used to develop an automatic prescreening system for eligible patients (n=765) and participants were randomised in a 1:1 ratio to either the nurse navigator-led ACP pathway or usual care. Our primary outcomes are documentation of ACP discussions within the EHR along with the quality of ACP discussions. Secondary outcomes include a broad range of ACP actions (eg, usage of ACP billing codes, choosing a surrogate decision-maker and advance directive documentation). Outcomes will be measured over 12 months of follow-up. ETHICS AND DISSEMINATION This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards. The results of this study will inform a scalable solution to ACP discussions throughout our healthcare system and statewide. TRIALS REGISTRATION NUMBER NCT03609658.
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Affiliation(s)
- Jennifer Gabbard
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - N M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathryn E Callahan
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristie Foley
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Keren Ferris
- Department of Internal Medicine,Section of Gerontology & Geriatric Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carl Grey
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeff Williamson
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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13
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Martín Lesende I, Mendibil Crespo LI, Martinez Blanco I, Porto Hormaza B, Maray Gondra B, Aguirre Basaras N. [Predictive validity of the VIDA questionnaire on functional decline, institutionalisation or death in patients with multiple morbidities]. Rev Esp Geriatr Gerontol 2019; 55:25-28. [PMID: 31506236 DOI: 10.1016/j.regg.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability. The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. METHODS A prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index. The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. RESULTS The median age was 81 years (IQR 74.5-85), and 45.2% were women. At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). CONCLUSIONS Overall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term.
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Affiliation(s)
| | | | | | | | | | - Nerea Aguirre Basaras
- Centro de Salud San Ignacio, OSI Bilbao-Basurto, Osakidetza, Bilbao, España; Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de Bizkaia, Bilbao, España
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