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Prediction of functional decline in community-dwelling older persons in general practice: a cohort study.

ABSTRACT: A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline.In this cohort study, embedded within the ISCOPE-trial, participants (?75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants. Functional status was measured at baseline and 12 months (Groningen Activities Restriction Scale [GARS]). The outcome was functional decline (death, nursing home admission, 10% with greatest functional decline). The predictive value of pre-selected variables (age, sex, polypharmacy, multimorbidity, living situation; GPs' opinion on vulnerability, number of domains with problems [ISCOPE-score]) was compared with the area under the curves (AUC) for logistic regression models.2018 of the 2211 participants (median age 82.1 years [IQR 78.8-86.5], 68.0% female, median GARS 31 [IQR 24-41]) were visited at 12 months (median GARS 34 [IQR 26-44]). 394 participants (17.8%) had functional decline (148 died, 45 nursing home admissions, 201 with greatest functional decline). The AUC for age and sex was 0.602, increasing to 0.620 (p?=?0.029) with polypharmacy, multimorbidity and living situation. The GPs' opinion added more (AUC 0.672, p?

SUBMITTER: van Blijswijk SCE

PROVIDER: S-EPMC6001140 | biostudies-other | 2018 Jun

REPOSITORIES: biostudies-other

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Prediction of functional decline in community-dwelling older persons in general practice: a cohort study.

van Blijswijk Sophie C E SCE Blom Jeanet W JW de Craen Anton J M AJM den Elzen Wendy P J WPJ Gussekloo Jacobijn J

BMC geriatrics 20180611 1

<h4>Background</h4>A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline.<h4>Methods</h4>In this cohort study, embedded within the ISCOPE-trial, participants (≥75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants. ...[more]

PMID: 29898672

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Project description:BackgroundSelf-reported data are often used for estimates on healthcare utilization in cost-effectiveness studies.ObjectiveTo analyze older adults' self-report of healthcare utilization compared to data obtained from the general practitioners' (GP) electronic medical record (EMR) and to study the differences in healthcare utilization between those who completed the study, those who did not respond, and those lost to follow-up.MethodsA prospective cohort study was conducted among community-dwelling persons aged 70 years and above, without dementia and not living in a nursing home. Self-reporting questionnaires were compared to healthcare utilization data extracted from the EMR at the GP-office.ResultsOverall, 790 persons completed questionnaires at baseline, median age 75 years (IQR 72-80), 55.8% had no disabilities in (instrumental) activities of daily living. Correlations between self-report data and EMR data on healthcare utilization were substantial for 'hospitalizations' and 'GP home visits' at 12 months intraclass correlation coefficient 0.63 (95% CI; 0.58-0.68). Compared to the EMR, self-reported healthcare utilization was generally slightly over-reported. Non-respondents received more GP home visits (p<0.05). Of the participants who died or were institutionalized 62.2% received 2 or more home visits (p<0.001) and 18.9% had 2 or more hospital admissions (p<0.001) versus respectively 18.6% and 3.9% of the participants who completed the study. Of the participants lost to follow-up for other reasons 33.0% received 2 or more home visits (p<0.01) versus 18.6 of the participants who completed the study.ConclusionsSelf-report of hospitalizations and GP home visits in a broadly 'healthy' community-dwelling older population seems adequate and efficient. However, as people become older and more functionally impaired, collecting healthcare utilization data from the EMR should be considered to avoid measurement bias, particularly if the data will be used to support economic evaluation.

Dataset Information

Prediction of functional decline in community-dwelling older persons in general practice: a cohort study.

Publications

Prediction of functional decline in community-dwelling older persons in general practice: a cohort study.

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