Long‐Term Nursing Home Entry: A Prognostic Model for Older Adults with a Family or Unpaid Caregiver

Wolff, Jennifer L.; Mulcahy, John; Roth, David L.; Cenzer, Irena Stijacic; Kasper, Judith D.; Huang, Jin; Covinsky, Kenneth E.

doi:10.1111/jgs.15447

Cited by 38 publications

(38 citation statements)

References 45 publications

(94 reference statements)

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“…However, regarding HC, although difficult to compare, similar rates were observed between homebound incidence in Japan 41 (32.1 per 1000 individuals/year) and that of our study (30.6 per individual/year). With respect to NH entry, we found lower rates than those reported by the USA 42 , 16.1% in two years; but closer to Germany, with rates of 4.7% in a three-year follow-up 43 . Again, institutionalization rates differ among countries, depending on organizational aspects, the availability of long-term beds and the responsibility for the care of disabled older individuals by different actors.…”

Section: Incidence Of Home Care and Nursing Home Entrycontrasting

confidence: 65%

The Impact Of Frailty On Admission To Home Care Services And Nursing Homes: Eight-Year Follow-Up Of A Community-Dwelling, Older Adult, Spanish Cohort

Cegri

Orfila

Abellana

et al. 2020

Preprint

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Background 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 Study design: prospective, multicenter, cohort study in 23 primary healthcare centers located in Catalonia, Spain, with an eight-year follow-up (2005-2013). Participants: the cohort was made up of 616 individuals. Data collection: baseline interview included a multidimensional assessment carried out by primary health care professionals. Outcome variables were collected during follow-up by consulting electronic healthcare records, telephone contacts, and the Central Registry of Catalonia for mortality. Statistical analysis: 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. The internal validity of the predictive models was tested for 150 bootstrap re-samples. Results At baseline, mean age was 76.4 years, 55.5% were women, and 22% lived alone. 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 competitive risk 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 the 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 the Daily Living, augmented 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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Section: Incidence Of Home Care and Nursing Home Entrycontrasting

confidence: 65%

The Impact Of Frailty On Admission To Home Care Services And Nursing Homes: Eight-Year Follow-Up Of A Community-Dwelling, Older Adult, Spanish Cohort

Cegri

Orfila

Abellana

et al. 2020

Preprint

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“…However, regarding HC, although di cult to compare, similar rates were observed between homebound incidence in Japan [41] (32.1 per 1000 individuals/year) and that of our study (30.6 per individual/year). With respect to NH entry, we found lower rates than those reported by the USA [42], 16.1% in two years; but closer to Germany, with rates of 4.7% in a three-year follow-up [43].…”

Section: Incidence Of Home Care and Nursing Home Entrycontrasting

confidence: 61%

The Impact of Frailty on Admission to Home Care Services and Nursing Homes: Eight-Year Follow-Up of a Community-Dwelling, Older Adult, Spanish Cohort

Cegri

Orfila

Abellana

et al. 2020

Preprint

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BackgroundFrailty 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. MethodsA 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.ConclusionsPrognostic 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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“…Research indicates that in addition to older adults' demographic characteristics and functional level, risk of nursing home utilization is also affected by factors related to family caregiving circumstances and experiences . One study examined the effect of California's PFL law on nursing home utilization by older adults in the state.…”

Section: Benefits Of Pflmentioning

confidence: 99%

“…5 Research indicates that in addition to older adults' demographic characteristics and functional level, risk of nursing home utilization is also affected by factors related to family caregiving circumstances and experiences. 22 One study examined the effect of California's PFL law on nursing home utilization by older adults in the state. The research found that the use of PFL by employed family caregivers in California showed an 11% reduction in older adults' nursing home utilization in that state between 1999 and 2008.…”

Section: Benefits Of Pflmentioning

confidence: 99%

Paid Family Leave: An Emerging Benefit for Employed Family Caregivers of Older Adults

Feinberg

2019

J American Geriatrics Society

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As our population ages, the ability to take time off to care for an ill family member or close friend without losing income or a job is a growing social, health, and economic issue for American families. Therefore, the need for paid family leave policies for workers with caregiving responsibilities is an important topic for employers and policymakers, in the clinical care of older adults, and at kitchen tables across the United States. Despite this growing need, paid family leave is not available to most workers, and there is no national paid family leave policy. Health care and social service providers have a role in ensuring that family members of their patients with a serious health condition or disability are aware of the potential availability of paid family leave benefits in the states and businesses that provide them. Building a better system of care for older adults means changes not only in health care settings and in long‐term services and supports, but in workplaces too. This article describes the challenges faced by workers with family caregiving responsibilities, explains why paid family leave matters, indicates which states have adopted these protections, and reviews research on existing paid family leave policies. Finally, actions by clinicians and other stakeholders are offered to advance awareness about paid family leave benefits, including coverage for workers with care responsibilities for older people.

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Long‐Term Nursing Home Entry: A Prognostic Model for Older Adults with a Family or Unpaid Caregiver

Abstract: We developed a prognostic model and simple scoring system that may be used to stratify risk of long-term NH entry of community-living older adults. Our model may be useful for population health and policy applications.

Cited by 38 publications

References 45 publications

The Impact Of Frailty On Admission To Home Care Services And Nursing Homes: Eight-Year Follow-Up Of A Community-Dwelling, Older Adult, Spanish Cohort

The Impact Of Frailty On Admission To Home Care Services And Nursing Homes: Eight-Year Follow-Up Of A Community-Dwelling, Older Adult, Spanish Cohort

The Impact of Frailty on Admission to Home Care Services and Nursing Homes: Eight-Year Follow-Up of a Community-Dwelling, Older Adult, Spanish Cohort

Paid Family Leave: An Emerging Benefit for Employed Family Caregivers of Older Adults

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