Tracking personalized functional health in older adults using geriatric assessments

Abstract

Background Higher levels of functional health in older adults leads to higher quality of life and improves the ability to age-in-place. Tracking functional health objectively could help clinicians to make decisions for interventions in case of health deterioration. Even though several geriatric assessments capture several aspects of functional health, there is limited research in longitudinally tracking personalized functional health of older adults using a combination of these assessments. Methods We used geriatric assessment data collected from 150 older adults to develop and validate a functional health prediction model based on risks associated with falls, hospitalizations, emergency visits, and death. We used mixed effects logistic regression to construct the model. The geriatric assessments included were Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Short Form 12 (SF12). Construct validators such as fall risks associated with model predictions, and case studies with functional health trajectories were used to validate the model. Results The model is shown to separate samples with and without adverse health event outcomes with an area under the receiver operating characteristic curve (AUC) of > 0.85. The model could predict emergency visit or hospitalization with an AUC of 0.72 (95% CI 0.65–0.79), fall with an AUC of 0.86 (95% CI 0.83–0.89), fall with hospitalization with an AUC of 0.89 (95% CI 0.85–0.92), and mortality with an AUC of 0.93 (95% CI 0.88–0.97). Multiple comparisons of means using Turkey HSD test show that model prediction means for samples with no adverse health events versus samples with fall, hospitalization, and death were statistically significant (p < 0.001). Case studies for individual residents using predicted functional health trajectories show that changes in model predictions over time correspond to critical health changes in older adults. Conclusions The personalized functional health tracking may provide clinicians with a longitudinal view of overall functional health in older adults to help address the early detection of deterioration trends and decide appropriate interventions. It can also help older adults and family members take proactive steps to improve functional health.

Prediction models for the prediction of unplanned hospital admissions in community-dwelling older adults: A systematic review

“…Of the 19 studies included, the majority were developed in the United States (n = 10) [28][29][30][31][32][33][34][35][36][37] and two in Italy [38,39]. The other studies were developed in the United Kingdom [40], Ireland [41], Canada [42], Sweden [43], Spain [44], Taiwan [45], and South-Korea [46].…”

“…Twelve studies included participants aged �65 years [29, 33, 35-39, 41, 42, 44-46], the remaining studies used a higher age as inclusion criterion with 81 years [30] as the highest minimum age for inclusion. Total sample sizes ranged from 150 [34] to 1,095,613 [39] participants. Two studies were developed in patients receiving home or community care [34,41], and one study developed a prediction model in older adults with a vision and/or hearing impairment [29].…”

The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians

“…The overall goal of all these approaches remains the same: keeping older persons safely in place, in harmony with their needs and according to their wishes and values. The personalized, integrated, and functionality-focused approach of GM favors this goal [ 39 ], counteracting the mainstream disease-focused approach.…”

Comprehensive Geriatric Assessment Using the Yoitoko Check-Up, a Novel Health Check-Up Providing Positive Feedback to Older Adults: A Before-After Study

“…The CGA is defined as a multidimensional, interdisciplinary diagnostic process for determining the medical, psychological, and functional abilities of frail older adults to develop a coordinated, integrated plan for treatment and long-term follow-up. 10 The CGA is associated with adverse health events such as death, disability, institutionalization, hospitalization, and falls; [10][11][12][13] therefore, the CGA is strongly associated with health status. The Yoitoko check-up assesses health improvements in older adults, such as the maintenance and improvement of items included in the CGA, and aims to promote positive behavioral changes related to these CGA items.…”

“…Therefore, it is possible that these scores may improve further with longer-term observation. The CGA, based on health screening items, suggests possible health indicators among older adults [10][11][12][13] such that increasing the CGA score may lead to improvements in health. Future research is needed; however, the findings in this study suggest that the positive feedback in terms of promoting desirable behavior through applying the Yoitoko check-up could foster health improvements among older adult participants.…”