Home Accessibility, Living Circumstances, Stage of Activity Limitation, and Nursing Home Use

Stineman, Margaret G.; Xie, Dawei; Streim, Joel E.; Pan, Qiang; Kurichi, Jibby E.; Henry-Sánchez, John T.; Zhang, Zi; Saliba, Debra

doi:10.1016/j.apmr.2012.03.027

Cited by 33 publications

(23 citation statements)

References 26 publications

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“…Previous studies have shown that more disabled baseline ADL stage has been associated with functional deterioration, 45 institutionalization, 45,46 and death 10,13,45,47 among the elderly. Beneficiaries categorized at more disabled activity limitation stages will have increased care burden which may require the need for institutionalization, or the burden may be so severe that the beneficiaries are at risk for death.…”

Section: Discussionmentioning

confidence: 97%

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Kurichi

Kwong

Xie

et al. 2017

PM&R

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Background Prediction models can help clinicians provide the best and most appropriate care to their patients and can help policy makers design services for groups at highest risk of poor outcomes. Objective The objective was to develop prediction models identifying both risk factors and protective factors for functional deterioration, institutionalization, and death. Design Cohort study using data from the Medicare Current Beneficiary Survey (MCBS) Setting Community survey. Participants This study included 21,264 Medicare beneficiaries 65 years of age and older who participated in the MCBS from the 2001–2008 entry panels and were followed for two years. Methods The index was derived in 60% and validated in the remaining 40%. β-coefficients from a multinomial logistic regression model were used to derive points, which were added together to create scores associated with the outcome. Main outcome measure The outcome was activity of daily living (ADL) stage transitions over two years following entry into the MCBS. Beneficiaries were categorized into one of four outcome categories: stable or improved function, functional deterioration, institutionalization, or death. Results Our model identified 16 factors for functional deterioration (age, gender, education, living arrangement, dual eligibility, proxy use, Alzheimer’s disease/dementia, angina pectoris/coronary heart disease, diabetes, emphysema/asthma/chronic obstructive pulmonary disease, mental/psychiatric disorder, Parkinson’s disease, stroke/brain hemorrhage, hearing impairment, vision impairment, and baseline ADL stage) after backward selection (p<.05). Compared to stable or improved function, the risk of functional deterioration ranged from ≤1 to ≥6, ≤4 to ≥22 for the risk of institutionalization, and ≤3 to ≥16 for the risk of death. Conclusion Predictive indices, or point and scoring systems used to predict outcomes, can identify elderly Medicare beneficiaries at risk of functional deterioration, institutionalization, and death and can aid policy makers, clinicians, and family members in improving care for older adults and supporting successful aging in the community.

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Section: Discussionmentioning

confidence: 97%

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Kurichi

Kwong

Xie

et al. 2017

PM&R

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“…34 Thus, it seems that both the perception of environmental barriers in the home and falling are most common among those at moderately severe stages of self-care limitation. Interestingly, Northridge and coworkers 21 report that vigorous older people were more susceptible to environmental hazards in the home and that home hazards were not associated with falling in those already considered frail.…”

Section: Discussionmentioning

confidence: 99%

“…32 People at higher ADL limitation stages tend to be older, to have a higher prevalence of chronic disabling conditions such as stroke, and to have higher likelihood of both short-term (1-yr) and long-term (10-yr) all-cause mortality. 33,34 …”

mentioning

confidence: 99%

Do Elderly People at More Severe Activity of Daily Living Limitation Stages Fall More?

Henry-Sánchez

Kurichi

Xie

et al. 2012

American Journal of Physical Medicine &Amp; Rehabilitation

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Henry-Sánchez JT, Kurichi JE, Xie D, Pan Q, Stineman MG: Do elderly people at more severe activity of daily living limitation stages fall more? Am J Phys Med Rehabil 2012;91:601–610. Objective The aim of this study was to explore how activity of daily living (ADL) stages and the perception of unmet needs for home accessibility features associate with a history of falling. Design Participants were from a nationally representative sample from the Second Longitudinal Survey of Aging conducted in 1994. The sample included 9250 community-dwelling persons 70 yrs or older. The associations of ADL stage and perception of unmet needs for home accessibility features with a history of falling within the past year (none, once, or multiple times) were explored after accounting for sociodemographic characteristics and comorbidities using a multinomial logistic regression model. Results The adjusted relative risk of falling more than once peaked at 4.30 (95% confidence interval, 3.29–5.61) for persons with severe limitation (ADL-III) compared those with no limitation (ADL-0) then declined for those at complete limitation (ADL-IV). The adjusted relative risks of falling once and multiple times were 1.42 (95% confidence interval, 1.07–1.87) and 1.85 (95% confidence interval, 1.44–2.36), respectively, for those lacking home accessibility features. Conclusions Risk of falling appeared greatest for those whose homes lacked accessibility features and peaked at intermediate ADL limitation stages, presumably at a point when people have significant disabilities but sufficient function to remain partially active.

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“…Environmental barriers and Person-Environment (P-E) fit problems in housing are associated with disability-related outcomes in older people (for a review, see [1]), and may also lead to increase in nursing home care [2]. It has also been found that barriers in the outdoor environment predict mobility decline [3-5], which has been identified as a significant predictor of mortality [6,7].…”

Section: Introductionmentioning

confidence: 99%

Environmental barriers, person-environment fit and mortality among community-dwelling very old people

et al. 2013

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BackgroundEnvironmental barriers are associated with disability-related outcomes in older people but little is known of the effect of environmental barriers on mortality. The aim of this study was to examine whether objectively measured barriers in the outdoor, entrance and indoor environments are associated with mortality among community-dwelling 80- to 89-year-old single-living people.MethodsThis longitudinal study is based on a sample of 397 people who were single-living in ordinary housing in Sweden. Participants were interviewed during 2002–2003, and 393 were followed up for mortality until May 15, 2012.Environmental barriers and functional limitations were assessed with the Housing Enabler instrument, which is intended for objective assessments of Person-Environment (P-E) fit problems in housing and the immediate outdoor environment. Mortality data were gathered from the public national register. Cox regression models were used for the analyses.ResultsA total of 264 (67%) participants died during follow-up. Functional limitations increased mortality risk. Among the specific environmental barriers that generate the most P-E fit problems, lack of handrails in stairs at entrances was associated with the highest mortality risk (adjusted RR 1.55, 95% CI 1.14-2.10), whereas the total number of environmental barriers at entrances and outdoors was not associated with mortality. A higher number of environmental barriers indoors showed a slight protective effect against mortality even after adjustment for functional limitations (RR 0.98, 95% CI 0.96-1.00).ConclusionSpecific environmental problems may increase mortality risk among very-old single-living people. However, the association may be confounded by individuals’ health status which is difficult to fully control for. Further studies are called for.

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Home Accessibility, Living Circumstances, Stage of Activity Limitation, and Nursing Home Use

Cited by 33 publications

References 26 publications

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries

Do Elderly People at More Severe Activity of Daily Living Limitation Stages Fall More?

Environmental barriers, person-environment fit and mortality among community-dwelling very old people

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