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Odden MC, Sims KD, Thorpe RJ, Sims M, Dhamoon M, Min YI, Correa A. Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study. J Gerontol A Biol Sci Med Sci 2021; 76:937-943. [PMID: 33075819 DOI: 10.1093/gerona/glaa272] [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: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. METHOD Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome. RESULTS Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation. CONCLUSION Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.
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Affiliation(s)
- Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University School of Medicine, California
| | - Kendra D Sims
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson
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Jacob ME, Marron MM, Boudreau RM, Odden MC, Arnold AM, Newman AB. Age, Race, and Gender Factors in Incident Disability. J Gerontol A Biol Sci Med Sci 2019; 73:194-197. [PMID: 29045556 DOI: 10.1093/gerona/glx194] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/09/2017] [Indexed: 11/14/2022] Open
Abstract
Background Incident disability rates enable the comparison of risk across populations. Understanding these by age, sex, and race is important for planning for the care of older adults and targeting prevention. Methods We calculated incident disability rates among older adults in the Cardiovascular Health Study, a study of 5,888 older adults aged ≥ 65 years over 6 years of follow-up. Disability was defined in the following two ways: (i) self-report of disability (severe difficulty or inability) in any of six Activities of Daily Living (ADL), and (ii) mobility difficulty (any difficulty walking half a mile or climbing 10 steps). Incident disability rates were calculated as events per 100 person years for age, gender, and race groups. Results The incidence of ADL disability, and mobility difficulty were 2.7 (2.5-2.8), and 9.8 (9.4-10.3) events per 100 person years. Women, older participants, and blacks had higher rates in both domains. Conclusion Incidence rates are considerably different based on the domain examined as well as age, race, and gender composition of the population. Prevention efforts should focus on high risk populations and attempt to ameliorate factors that increase risk in these groups.
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Affiliation(s)
- Mini E Jacob
- School of Public Health, Boston University, New England GRECC, VA Boston Healthcare System, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts
| | - Megan M Marron
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Michelle C Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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Wrights AP, Fain CW, Miller ME, Rejeski WJ, Williamson JD, Marsh AP. Assessing physical and cognitive function of older adults in continuing care retirement communities: who are we recruiting? Contemp Clin Trials 2014; 40:159-65. [PMID: 25510892 DOI: 10.1016/j.cct.2014.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/04/2014] [Accepted: 12/06/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE In partnership with six Continuing Care Retirement Communities (CCRCs), the current study focused on the feasibility of recruiting a representative sample of residents and then assessing their functional health. MATERIAL AND METHODS With our guidance, each of the six CCRCs recruited a volunteer (V-Group) and random (R-Group) sample of independent living residents. We provided face-to-face training and ongoing remote electronic support to the CCRC staff on the testing battery and the Web-based data entry system. The testing battery was consisted of demographic, physical function, and psychosocial assessments. RESULTS After training, CCRC staff were receptive to the study goals and successfully used the data entry Website. In the V-Group (N=189), 76% were already participating in CCRC wellness programs. We attempted to recruit a random, unbiased (R-Group) sample of 20% (n=105) of eligible residents; however, only 30 consented to be tested and 70% of this group (21/30) were also already participating in a wellness program. Mean age of all participants was 82.9 years. The V-Group had a higher Short Physical Performance Battery (SPPB) total score (least squares mean [SE], 9.4 [0.2] vs 8.2 [0.4], p=0.014) and SPPB gait speed component score (3.5 [0.1] vs 3.0 [0.2], p=0.007) and spent more time doing moderate-to-vigorous physical activity (300 [21] vs 163 [49] min/week, p=0.013) compared to the R-Group. IMPLICATIONS While it is feasible to recruit, assess and transmit data on residents' functional health in partnership with CCRCs, population validity was severely compromised. Attention needs to be given to the development of more effective methods to recruit less interested residents.
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Affiliation(s)
- Abbie P Wrights
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Christie W Fain
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Jeff D Williamson
- Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States.
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Wang SY, Shamliyan TA, Talley KM, Ramakrishnan R, Kane RL. Not just specific diseases: Systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Arch Gerontol Geriatr 2013; 57:16-26. [DOI: 10.1016/j.archger.2013.03.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/11/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
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Tsai HJ. Cross-sectional and longitudinal associations of functional and health status with institutional care use: results from the Survey of Health and Living Status of the Elderly in Taiwan. Geriatr Gerontol Int 2012; 13:597-606. [PMID: 22994918 DOI: 10.1111/j.1447-0594.2012.00944.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This study evaluated the cross-sectional and longitudinal associations of functional and health status with institutional care, and examined determinants of institutional care use over time. METHODS Data of this study were obtained from the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET), which was launched in 1989 and involved a nationally representative sample of nearly-old and old Taiwanese. The baseline data in this present study were collected in 1999, and followed in 2003 and 2007. RESULTS Participants with institutional care use had a higher activities of daily living (ADL) score, more self-reported diseases and poorer self-reported health status than participants without institutional care use (all P<0.05). Cross-sectional analysis showed that a higher ADL score, having heart diseases and having a stroke were positively associated with institutional care use (P<0.05); whereas the number of self-reported diseases and poor self-reported health status were not associated with institutional care use. Longitudinal analysis showed that increased ADL scores and the number of self-reported diseases over 4- and 8 years were associated with an increased likelihood of subsequent institutional care use (all P<0.05). Worsening health status over 4 years was associated with an increased likelihood of subsequent institutional care use, but this association did not exist over 8 years. CONCLUSIONS Only ADL and ADL deterioration over time are cross-sectionally and longitudinally associated with increased institutional care use. Declining functional status is a major determinant of institutional care use for Taiwanese aged over 53 years.
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Affiliation(s)
- Hsin-Jen Tsai
- Department of Health Management, I-Shou University, Kaohsiung, Taiwan.
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Transferring to an Institution — An Analysis of Factors behind the Transfer to Institutional Long-Term Care. Can J Aging 2010. [DOI: 10.1017/s0714980800005869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉL'analyse vise à déterminer l'incidence de divers facteurs sur le transfert de patients entre les différents niveaux de soins d'un système local de soins de longue durée aux personnes âgées et aux invalides. Une attention particulière est attachée au passage de soins non-institutionnels aux soins instutionnels. Cette analyse utilise des données recueillies, entre 1985 et 1991, dans la commune de Solna, Suède, au moyen de l'application du système de contrôle ASIM. L'analyse porte sur les facteurs âge, sexe, situation de famille, cohabitation, accessibilité au logement, soutien social informel et différentes forme d'invalidité. Il résulte de l'analyse à multivariées portant sur les facteurs relatifs à l'institutionnalisation — c'est-à-dire le transfert de personnes ayant bénéficié de soins à domicile ou ayant occupé un appartement dans un immeuble à services intégrés à une maison de retraite ou à un établissement hospitalier de soins de longue durée ou à une maison de soins — que le niveau d'invalidité, le jugement porté par le personnel sur le niveau de soins approprié et l'âge étaient les facteurs les plus significatifs. La démence sénile était le facteur d'invalidité individuel le plus important, des handicaps fonctionnels et l'incontinence influant également dans une certaine mesure sur la probabilité de transfert. La déficience de l'environnement social, telles que célibat, accessibilité insuffisante au logement ou manque de soutien social ne semblaient pas pertinents — probablement parce qu'elles étaient compensées de manière adéquate par le service public d'aide familiale.
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Validity and responsiveness of the spinal cord index of function: an instrument on activity level. Spinal Cord 2009; 47:817-21. [DOI: 10.1038/sc.2009.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kenny AM, Smith J, Noteroglu E, Waynik IY, Ellis C, Kleppinger A, Annis K, Dauser D, Walsh S. Osteoporosis risk in frail older adults in assisted living. J Am Geriatr Soc 2008; 57:76-81. [PMID: 19054182 DOI: 10.1111/j.1532-5415.2008.02072.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare osteoporosis risk in residents of assisted living (AL) with that of age- and sex-matched community-dwelling adults. DESIGN Cross-sectional. SETTING Community and AL facilities in Connecticut. PARTICIPANTS One hundred seven individuals (77 control, 37 AL). ASSESSMENTS Fracture and osteoporosis evaluation history, qualitative heel ultrasound (QUS), 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), and physical function measures, including walking speed, chair rise time, 6-minute walk, Berg Balance Scale, Get Up and Go, and handgrip strength. RESULTS Participants' mean age was 82.7+/-5.7. There were no group differences in reported fracture, diagnosis of osteoporosis, or previous bone mineral density (BMD) assessment. QUS T-scores were -1.0+/-1.5 for community living and -1.9+/-1.3 for AL (P=.002), 25OHD levels were 113.0+/-40.1 nnmol/L for community living and 81.8+/-36.9 for AL (P<.001), and PTH levels were 50.8+/-29.8 pg/mL for community living and 58.8+/-32.8 pg/mL for AL (P=.22). Physical performance was more impaired in AL (P<.05), except for single leg stance (P=.16). In linear regression analysis, age, sex, and site of residence were significant predictors of heel T-score, explaining 53.7% of the variance. CONCLUSION Residents of AL did not report less fracture or osteoporosis than those from the community, but risk factors measured directly were significantly different, including lower BMD and 25OHD and more impairment in measures of physical function. These data suggest that residents of AL are at greater risk for osteoporotic fracture and that measures to diminish risk (optimizing vitamin D status, implementing fall prevention strategies, incorporating exercise to improve physical performance) should be considered and studied for benefit.
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Affiliation(s)
- Anne M Kenny
- University of Connecticut Health Center, Farmington, Connecticut 06030-5215, USA.
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Factors Associated With Skilled Nursing Facility Transfers in Dementia-specific Assisted Living. Alzheimer Dis Assoc Disord 2008; 22:255-60. [DOI: 10.1097/wad.0b013e31816c92d5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McCarron M, McCallion P. A Revised Stress and Coping Framework for Staff Carers of Persons with Intellectual Disabilities and Dementia. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2005. [DOI: 10.1111/j.1741-1130.2005.00024.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hoenig H, Hoff J, McIntyre L, Branch LG. The self-reported functional measure: Predictive validity for health care utilization in multiple sclerosis and spinal cord injury. Arch Phys Med Rehabil 2001; 82:613-8. [PMID: 11346837 DOI: 10.1053/apmr.2001.20832] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the predictive validity of the Self-Reported Functional Measure (SRFM), a new measure derived from the FIMtrade mark instrument, for health care utilization in multiple sclerosis (MS) and spinal cord injury (SCI). DESIGN Prospective cohort study using a mailed survey in 1995 and administrative records from 1996 and 1997. SETTING Veterans Health Administration hospitals and outpatient clinics. PATIENTS A total of 6361 veterans with SCI and 1789 veterans with MS. MAIN OUTCOME MEASURES SRFM score was compared with subsequent outpatient visits, hospitalizations, hospital lengths of stay (LOSs), and residence peri-hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for these variables. RESULTS A total of 3836 subjects (47.6%) were hospitalized during 1996-1997, and all but 874 (10.7%) had 1 or more outpatient visits. SRFM score predicted inpatient, but not outpatient health care utilization. Persons in the lowest SRFM quartile were over 90% (OR = 1.91, 95% CI = 1.71-2.13) more likely to be hospitalized compared with those in the highest SRFM quartile; also, they were over 2 times (OR = 2.18, 95% CI = 1.85-2.57) more likely to have a LOS greater than 7 days, were over 2 times (OR = 2.41, 95% CI = 1.62-3.58) more likely to die in hospital, and were nearly 3 times (OR = 2.86, 95% CI = 2.00-4.08) more likely to be discharged to an institution. CONCLUSIONS SRFM had excellent predictive validity for hospitalization, LOS, and discharge destination among patients with MS or SCI.
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Affiliation(s)
- H Hoenig
- Physical Medical and Rehabilitation Service, Health Services Research and Development Field Program, Durham Veterans Administration Medical Center, Durham, NC, USA.
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Hoenig H, Branch LG, McIntyre L, Hoff J, Horner RD. The validity in persons with spinal cord injury of a self-reported functional measure derived from the functional independence measure. Spine (Phila Pa 1976) 1999; 24:539-43; discussion 543-4. [PMID: 10101817 DOI: 10.1097/00007632-199903150-00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional, mailed survey on impairment and function using 6361 respondents to the Spinal Cord Dysfunction National Veterans Survey who reported spinal cord injury as the sole cause of their spinal cord dysfunction. OBJECTIVES To establish the concurrent and construct validities of a Self-Reported Functional Measure appropriate for use in patients with spinal cord injuries. SUMMARY OF BACKGROUND DATA Functional assessment is of increasing importance in clinical care, quality assurance, and national health-care planning. There is a conspicuous need for validated functional assessment measures that are rapid, reliable, and appropriate for use in the disabled population. METHODS The correlation was examined of hours of personal assistance, number of affected limbs, amount of motor impairment, and amount of combined limb-motor impairment to Self-Reported Functional Measure response tertile (scores, 13-32, 33-45, 46-52; lower scores indicated worse function). RESULTS There were statistically significant correlations between Self-Reported Functional Measure score and hours of personal assistance (P < 0.001), the number of affected limbs (P < 0.001), the amount of motor impairment (P < 0.001), and the amount of combined limbmotor impairment (P < 0.001). For example, 87% of people with the most limb-motor impairment (four affected limbs and no useful movement) were in the lowest Self-Reported Functional Measure tertile, compared with 3% of people in the least-affected category of limb-motor impairment. Furthermore, visual, sensory, or memory impairment did not influence the correlation between limbmotor impairment and Self-Reported Functional Measure score. CONCLUSION The Self-Reported Functional Measure shows good concurrent and construct validities.
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Affiliation(s)
- H Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, North Carolina, USA
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Hoenig H, McIntyre L, Sloane R, Branch LG, Truncali A, Horner RD. The reliability of a self-reported measure of disease, impairment, and function in persons with spinal cord dysfunction. Arch Phys Med Rehabil 1998; 79:378-87. [PMID: 9552102 DOI: 10.1016/s0003-9993(98)90137-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To develop a self-report instrument that would provide information about the different levels of the disablement process, and that (1) was suitable for persons with spinal cord disease (SCD), (2) could be completed quickly, (3) could be mailed, (4) had acceptable reliability, and (5) would be clinically useful. STUDY DESIGN Test-retest using a convenience sample. METHODS Review of the literature and an expert panel were used to develop the instrument. It was mailed to 49,458 individuals in June 1995 and a second mailing was done in August 1995. A subset of 725 individuals who responded to both mailings was used to examine the instrument's test-retest reliability. RESULTS The instrument has a 4th grade reading level and has questions on causal disease, disease severity, impairment, activities of daily living (including a self-reported version of the Functional Independence Measure, the SRFM), and resource utilization. Individual item test-retest reliability was high for a mailed questionnaire; all kappa coefficients were near or above .60 and most were over .70. Intraclass correlation coefficient for the SRFM was .90 and internal consistency (Chronbach's alpha) was .96. CONCLUSION This instrument provides a new, rapid way to obtain information relative to the differing levels of the disablement process.
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Affiliation(s)
- H Hoenig
- Durham Veterans Administration Medical Center and Duke University Medical Center, NC 27705, USA
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Lagergren M. Determining the appropriate level of care. An analysis of factors affecting the staff's overall needs assessments, using data collected through the ASIM monitoring system. SCANDINAVIAN JOURNAL OF SOCIAL MEDICINE 1995; 23:209-215. [PMID: 8602492 DOI: 10.1177/140349489502300312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
For the purpose of evaluating the validity of the staff's overall needs assessment in terms of the 'appropriate level of care' as a measurement of resource needs--with particular emphasis on the need for institutional resources--an analysis was made concerning the relation of the assessment to various other factors. In the analysis, we used data collected in a survey undertaken in Solna municipality on November 1, 1991 according to the ASIM monitoring system. It was found by multiple regression analysis, that the 'appropriate level of care' was closely related to the client's degree of disability, age, and actual level of care. On the other hand, variables describing the client's social situation--marital status, single-living, informal social support, standard and accessibility of housing--bore no relation to the assessment of need for institutional care. Chiefly because of the close relation to the actual level of care it was concluded that the staff's overall assessment of 'appropriate level of care' should be used with a degree of caution as measure of the need for institutional resources, since it would tend to overrate that need. A more systematic needs assessment procedure is required in order to provide the municipal authorities with unbiased estimates of institutional resource needs.
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Affiliation(s)
- M Lagergren
- Karolinska Institute, Dept. of Social Medicine, Kronan Health Centre
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Osterweil D, Martin M, Syndulko K. Predictors of skilled nursing placement in a multilevel long-term-care facility. J Am Geriatr Soc 1995; 43:108-12. [PMID: 7836633 DOI: 10.1111/j.1532-5415.1995.tb06374.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine if cognitive and functional data gathered before admission to residential care (i.e., board and care) placement can predict nursing home placement. DESIGN Retrospective study using Cox proportional hazards analysis and pairwise assessment of adjusted relative risk factors to determine which independent variables predicted skilled nursing placement. Subjects were followed for an average of 23.7 months (SD = 18.6 months). SETTING Multilevel 1,735-bed long-term care facility, Jewish Home for the Aging, Reseda, California. PARTICIPANTS Of the 248 consecutive residential care admissions studied, 80% were women. Subject's mean age was 84.8 years (SD = 5.0); 67% had no significant cognitive impairment. INDEPENDENT VARIABLES Categorical variables were classifications with respect to dementia status, incontinence, hearing, and ambulation. Interval variables were number of medications, Katz ADL, and five neuropsychological tests. Demographic variables were gender, age, language of origin, and education. OUTCOME VARIABLE Time between preadmission testing and the move up to skilled nursing placement. RESULTS Pairwise assessment of adjusted potential risk factors indicated that cognitive dysfunction, less than perfect Katz ADL performance, and hearing loss were the most important independent risk factors for nursing placement. CONCLUSIONS The findings remind us to pay careful attention to residents exhibiting even relatively mild cognitive deficits upon admission because these residents are likely to need increased environmental support.
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Affiliation(s)
- D Osterweil
- Jewish Home for the Aging, Reseda, CA 91335-3798
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Siu AL, Reuben DB, Ouslander JG, Osterweil D. Using multidimensional health measures in older persons to identify risk of hospitalization and skilled nursing placement. Qual Life Res 1993; 2:253-61. [PMID: 8220360 DOI: 10.1007/bf00434797] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We examine the relationship between multidimensional measures of function and outcomes in a cohort of older persons admitted to the residential care level of a multi-level long-term care facility. We collected self-reported measures of various aspects of health using the Medical Outcome Study Short-form Health Survey (SF-20) and the Dartmouth COOP charts, as well as performance-based measures of physical and cognitive function. Subjects (mean age 84.3 years) were followed for a median of 557 days. In multivariate analyses, emotional function (measured by either the SF-20 or COOP method) was a predictor of placement in skilled care. Self-reported overall health (measured by either the SF-20 or COOP method) and timed manual performance were predictive of hospitalization. Change on the functional status measures between 2 points in time was not associated with later placement in skilled care except in the case of timed manual performance. In an older population at risk for frequent and numerous health events, this study shows that two popularized self-report methods for assessing function yield results that predict future outcomes of great importance to older persons. However, measures that predict use of long-term care may not predict use of the hospital and vice versa.
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Affiliation(s)
- A L Siu
- UCLA Multicampus Program in Geriatric Medicine and Gerontology
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