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Research article
Francesc Orfila
Institut Catala De La Salut
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2409-1731
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Geriatrics.
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.
Keywords
cohort study, frail elderly, primary health care, risk prediction models, long-term home care, long-term institutional care
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CURRENT STATUS: Published
Version 3
Posted 04 Aug, 2020
Published
On 06 Aug, 2020
No community comments so far
Editorial decision: Accept
On 29 Jul, 2020
Editor assigned
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 20 Jul, 2020
Review #1 received
Received 30 Mar, 2020
Reviewer #2 agreed
On 24 Mar, 2020
Reviewer #1 agreed
On 19 Mar, 2020
Reviewers invited
Invitations sent on 18 Mar, 2020
Editor assigned
On 10 Mar, 2020
Submission checks complete
On 09 Mar, 2020
Editor invited
On 09 Mar, 2020
No comments provided
Review #2 received
Received 08 Feb, 2020
Editorial decision: Major revision
On 08 Feb, 2020
Reviewer #2 agreed
On 13 Jan, 2020
Review #1 received
Received 24 Nov, 2019
Reviewer #1 agreed
On 12 Nov, 2019
Reviewers invited
Invitations sent on 25 Oct, 2019
Submission checks complete
On 20 Oct, 2019
Editor assigned
On 11 Oct, 2019
First submitted
On 10 Oct, 2019
Editor invited
On 10 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Geriatrics & Gerontology
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This preprint is under consideration at BMC Geriatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Francesc Orfila
Institut Catala De La Salut
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2409-1731
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 04 Aug, 2020
Published
On 06 Aug, 2020
No community comments so far
Editorial decision: Accept
On 29 Jul, 2020
Editor assigned
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 20 Jul, 2020
Review #1 received
Received 30 Mar, 2020
Reviewer #2 agreed
On 24 Mar, 2020
Reviewer #1 agreed
On 19 Mar, 2020
Reviewers invited
Invitations sent on 18 Mar, 2020
Editor assigned
On 10 Mar, 2020
Submission checks complete
On 09 Mar, 2020
Editor invited
On 09 Mar, 2020
No comments provided
Review #2 received
Received 08 Feb, 2020
Editorial decision: Major revision
On 08 Feb, 2020
Reviewer #2 agreed
On 13 Jan, 2020
Review #1 received
Received 24 Nov, 2019
Reviewer #1 agreed
On 12 Nov, 2019
Reviewers invited
Invitations sent on 25 Oct, 2019
Submission checks complete
On 20 Oct, 2019
Editor assigned
On 11 Oct, 2019
First submitted
On 10 Oct, 2019
Editor invited
On 10 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Geriatrics & Gerontology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Geriatrics.
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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