Dataset Information

Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex.

ABSTRACT:

Background

The identification of contextual factors that modify associations between client frailty and their health and service use outcomes is essential for informed home health care and policy planning. Our objective was to examine variation in the associations between frailty and select 1-year health outcomes by caregiver distress and client sex among community-residing older care recipients.

Methods

We conducted a retrospective cohort study using linked population-based clinical and health administrative databases for all long-stay home care clients (n?=?234,552) aged 66+ years assessed during April 2010-2013 in Ontario, Canada. Frailty was assessed using a previously validated 72-item frailty index (FI). Presence of caregiver distress was derived from clinical assessment items administered by trained home care assessors. Multivariable log-binomial regression models were used to examine variations in the associations between frailty and outcomes of interest (mortality, nursing home [NH] placement, all-cause and prolonged hospitalization) by caregiver distress, with further model stratification by client sex.

Results

Frailty prevalence varied little by sex (19.3% women, 19.9% men) despite significant sex-differences in clients' sociodemographic and health characteristics. In both sexes, frailty was significantly associated with all outcomes, particularly NH placement (RR?=?3.84, 95%CI 3.75-3.93) and death (RR?=?2.32, 95%CI 2.27-2.37), though risk ratios were greater for women. Caregiver distress was more common with increasing frailty and for male clients, and a significant independent predictor of NH placement and prolonged hospitalization in both sexes. The association between frailty and NH placement (but not other outcomes) varied by caregiver distress for both men and women (p?ConclusionsAs caregiver distress varies by client sex, represents a key driver of NH placement (even among relatively robust clients), and modifies the impact of other risk factors such as frailty, it should be routinely assessed. Further, sex-differences should be considered when developing and evaluating community-based services for older adults and their caregivers.

SUBMITTER: Maxwell CJ

PROVIDER: S-EPMC6134755 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Publications

Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex.

Maxwell Colleen J CJ Campitelli Michael A MA Diong Christina C Mondor Luke L Hogan David B DB Amuah Joseph E JE Leslie Sarah S Seitz Dallas D Gill Sudeep S Thavorn Kednapa K Wodchis Walter P WP Gruneir Andrea A Teare Gary G Bronskill Susan E SE

BMC geriatrics 20180912 1

<h4>Background</h4>The identification of contextual factors that modify associations between client frailty and their health and service use outcomes is essential for informed home health care and policy planning. Our objective was to examine variation in the associations between frailty and select 1-year health outcomes by caregiver distress and client sex among community-residing older care recipients.<h4>Methods</h4>We conducted a retrospective cohort study using linked population-based clini ...[more]

PMID: 30208884

Similar Datasets

Project description:BACKGROUND:Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0% to 59.1%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. OBJECTIVE:The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. METHODS:From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. RESULTS:A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). CONCLUSIONS:We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services.

Dataset Information

Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex.

Background

Methods

Results

Publications

Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex.

Similar Datasets

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