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

Abstract

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.

Cuidado integral em saúde

“…trabalhos, variando, entre os anos de publicação, de 1993 a 2017, sendo todos na língua inglesa (Colantonio et al, 1993;Colantonio et al, 1996;Glasser et al, 1997;Schmidt et al, 2000;Evans et al, 2002;Kao e Mchugh, 2004;Weir et al, 2005;Nihtilä et al, 2007;Pasquini et al, 2007;Walsh et al, 2008;Buntin et al, 2010;Luengo-Fernandez et al, 2013;Turco et al, 2013;Chau et al, 2014;Bell et al, 2015;Rapp et al, 2015;Sibolt et al, 2015;Kushner et al, 2016;Kurichi et al, 2017). Quanto ao tipo de estudo, nota-se uma predominância de artigos de coorte prospectiva.…”

“…Além disso, a institucionalização esteve mais presente que a mortalidade (Nihtilä et al, 2007;Rapp et al, 2015). Apenas um estudo relatou não existir relação entre o AVE e a institucionalização (Tabela 2) (Kurichi et al, 2017).…”

A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality Among Medicare Beneficiaries

“…IADLs play an important role in independent community living as they assess an individual’s ability to manage finances, go shopping, and carry out other important aspects of daily life. IADL stage transitions show a similar relationship to ADL stage transitions in relation to predictive factors, 13 suggesting that these assessments of functioning may share common characteristics as well as prognostic purposes. However, there are several differences in the prognosis of IADL and ADL stage transition deterioration that are worthy of attention.…”

“…Our findings build on prior work showing that demographic and clinical characteristics can predict functional decline as assessed by ADL activity limitation stage transitions. 13 This is the first study to examine predictors of IADL stage transitions and to establish a corresponding risk scoring system for use in clinical practice. IADLs play an important role in independent community living as they assess an individual’s ability to manage finances, go shopping, and carry out other important aspects of daily life.…”

“…8 In addition, we have assessed a risk scoring system for functional deterioration using ADL activity limitation stages in prior work. 13 No known work has examined and developed a risk scoring system for functional deterioration using IADL activity limitation stages. IADLs are more complex than ADLs and may be the first indication of decline.…”