Background
Frailty in older adults is a common multidimensional clinical entity, a state of vulnerability to stressors that increases the risk of adverse outcomes such as functional decline, institutionalization or death. The aim of this study is to identify the factors that anticipate the future inclusion of community-dwelling individuals aged ≥70 years in home care programmes (HC) and nursing homes (NH), and to develop the corresponding prediction models.
Methods
A prospective cohort study was conducted in 23 primary healthcare centers located in Catalonia, Spain, with an eight-year follow-up (2005-2013). The cohort was made up of 616 individuals. Data collection included a baseline multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic healthcare records, and the Central Registry of Catalonia for mortality. A prognostic index for a HC and NH at eight years was estimated for each patient. Death prior to these events was considered a competing risk event, and Fine–Gray regression models were used.
Results
At baseline, mean age was 76.4 years and 55.5% were women. During follow-up, 19.2% entered a HC program, 8.2% a NH, and 15.4% died without presenting an event. Of those who entered a NH, 31.5% had previously been in a HC program.
Multivariate models for a HC and NH showed that the risk of a HC entry was associated with older age, dependence on the Instrumental Activities of Daily Living, and slow gait measured by Timed-up-and-go test. An increased risk of being admitted to a NH was associated with older age, dependence on the Instrumental Activities of Daily Living, number of prescriptions, and the presence of social risk.
Conclusions
Prognostic models based on comprehensive geriatric assessments can predict the need for the commencement of HC and NH admission in community-dwelling older adults. Our findings underline the necessity to measure functional capacity, mobility, number of prescriptions, and social aspects of older adults in primary healthcare centers. In such a setting they can be offered longitudinal holistic assessments so as to benefit from preventive actions in order to remain independent in the community for as long as possible.
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Posted 04 Aug, 2020
On 06 Aug, 2020
On 29 Jul, 2020
On 28 Jul, 2020
On 27 Jul, 2020
On 27 Jul, 2020
On 20 Jul, 2020
Received 30 Mar, 2020
On 24 Mar, 2020
On 19 Mar, 2020
Invitations sent on 18 Mar, 2020
On 10 Mar, 2020
On 09 Mar, 2020
On 09 Mar, 2020
Received 08 Feb, 2020
On 08 Feb, 2020
On 13 Jan, 2020
Received 24 Nov, 2019
On 12 Nov, 2019
Invitations sent on 25 Oct, 2019
On 20 Oct, 2019
On 11 Oct, 2019
On 10 Oct, 2019
On 10 Oct, 2019
Posted 04 Aug, 2020
On 06 Aug, 2020
On 29 Jul, 2020
On 28 Jul, 2020
On 27 Jul, 2020
On 27 Jul, 2020
On 20 Jul, 2020
Received 30 Mar, 2020
On 24 Mar, 2020
On 19 Mar, 2020
Invitations sent on 18 Mar, 2020
On 10 Mar, 2020
On 09 Mar, 2020
On 09 Mar, 2020
Received 08 Feb, 2020
On 08 Feb, 2020
On 13 Jan, 2020
Received 24 Nov, 2019
On 12 Nov, 2019
Invitations sent on 25 Oct, 2019
On 20 Oct, 2019
On 11 Oct, 2019
On 10 Oct, 2019
On 10 Oct, 2019
Background
Frailty in older adults is a common multidimensional clinical entity, a state of vulnerability to stressors that increases the risk of adverse outcomes such as functional decline, institutionalization or death. The aim of this study is to identify the factors that anticipate the future inclusion of community-dwelling individuals aged ≥70 years in home care programmes (HC) and nursing homes (NH), and to develop the corresponding prediction models.
Methods
A prospective cohort study was conducted in 23 primary healthcare centers located in Catalonia, Spain, with an eight-year follow-up (2005-2013). The cohort was made up of 616 individuals. Data collection included a baseline multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic healthcare records, and the Central Registry of Catalonia for mortality. A prognostic index for a HC and NH at eight years was estimated for each patient. Death prior to these events was considered a competing risk event, and Fine–Gray regression models were used.
Results
At baseline, mean age was 76.4 years and 55.5% were women. During follow-up, 19.2% entered a HC program, 8.2% a NH, and 15.4% died without presenting an event. Of those who entered a NH, 31.5% had previously been in a HC program.
Multivariate models for a HC and NH showed that the risk of a HC entry was associated with older age, dependence on the Instrumental Activities of Daily Living, and slow gait measured by Timed-up-and-go test. An increased risk of being admitted to a NH was associated with older age, dependence on the Instrumental Activities of Daily Living, number of prescriptions, and the presence of social risk.
Conclusions
Prognostic models based on comprehensive geriatric assessments can predict the need for the commencement of HC and NH admission in community-dwelling older adults. Our findings underline the necessity to measure functional capacity, mobility, number of prescriptions, and social aspects of older adults in primary healthcare centers. In such a setting they can be offered longitudinal holistic assessments so as to benefit from preventive actions in order to remain independent in the community for as long as possible.
Figure 1
Figure 2
Figure 3
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