Trajectories of Functional Decline and Predictors in Long-term Care Settings: a Retrospective Cohort Analysis of Canadian Nursing Home Residents

Overview

Journal Age Ageing

Publisher Oxford University Press

Specialty Geriatrics

Date 2024 Dec 10

PMID 39656765

Authors

Bonaventure Amandi Egbujie

Luke Andrew Turcotte

George Heckman

John P Hirdes

Affiliations

Soon will be listed here.

Abstract

Methods: This is a 36 months' retrospective longitudinal analysis of LTC residents in five Canadian provinces. Group-based trajectory modelling (GBTM) was performed to identify distinct trajectories and resident attributes associated with membership of the trajectory groups.

Results: A total of 204 036 LTC residents were included in this study. Their admission mean age was 83.7 years (SD = 8.6), and 63.3% were females. Our model identified four distinct trajectories namely: 'Catastrophic decline' (n = 48 441, 22.7%), 'Rapid decline with some recovery' (n = 27 620, 18.7%), 'Progressive decline' trajectory (n = 30 287, 14.4%), and the 'No/Minimal decline' (n = 97 688, 47.9%) Residents' admission ADL Hierarchy score was the single, strongest predictor of functional decline trajectory that residents followed. Residents with ADLH 5-6 OR 0.03 (0.03-0.04) were least likely to follow a catastrophic decline trajectory, while those with ADLH 5-6 OR 39.05 (36/60-41.88) were most likely to follow a minimal or no decline trajectory.

Conclusion: Results of this study further highlight the heterogeneity of health trajectory among residents in LTC setting, re-affirming the need for personalized care. The study shows who among residents would be most at risk for different levels of functional decline.The study findings provide useful information that would assist both immediate and advanced care planning as well as to forecast care personnel requirements into the future based on total acuity levels of residents.

References

Covinsky K, Palmer R, Fortinsky R, Counsell S, Stewart A, Kresevic D . Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51(4):451-8. DOI: 10.1046/j.1532-5415.2003.51152.x. View

Banaszak-Holl J, Liang J, Quinones A, Cigolle C, Lee I, Verbrugge L . Trajectories of functional change among long stayers in nursing homes: does baseline impairment matter?. J Aging Health. 2011; 23(5):862-82. PMC: 7138515. DOI: 10.1177/0898264311399759. View

Turcotte L, Heckman G, Hebert P, Weir J, Mulla R, Hirdes J . . Sante Publique. 2022; 34(3):359-369. DOI: 10.3917/spub.223.0359. View

Molla-Casanova S, Pedrero-Sanchez J, Ingles M, Lopez-Pascual J, Munoz-Gomez E, Aguilar-Rodriguez M . Impact of Parkinson's Disease on Functional Mobility at Different Stages. Front Aging Neurosci. 2022; 14:935841. PMC: 9249436. DOI: 10.3389/fnagi.2022.935841. View

Yoon J, Brown R, Bowers B, Sharkey S, Horn S . The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study. Int J Nurs Stud. 2015; 53:238-47. PMC: 4679482. DOI: 10.1016/j.ijnurstu.2015.07.010. View

Morris J, Berg K, Howard E, Jonsson P, Craig M . Functional Recovery Within a Formal Home Care Program. J Am Med Dir Assoc. 2019; 20(8):1001-1006. DOI: 10.1016/j.jamda.2018.12.014. View

Fries B, Schneider D, Foley W, Gavazzi M, Burke R, Cornelius E . Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III). Med Care. 1994; 32(7):668-85. DOI: 10.1097/00005650-199407000-00002. View

Oida Y, Kitabatake Y, Nishijima Y, Nagamatsu T, Kohno H, Egawa K . Effects of a 5-year exercise-centered health-promoting programme on mortality and ADL impairment in the elderly. Age Ageing. 2003; 32(6):585-92. DOI: 10.1093/ageing/afg123. View

Suijker J, van Rijn M, Riet G, Moll van Charante E, de Rooij S, Buurman B . Minimal Important Change and Minimal Detectable Change in Activities of Daily Living in Community-Living Older People. J Nutr Health Aging. 2017; 21(2):165-172. DOI: 10.1007/s12603-016-0797-8. View

10.

Palese A, Menegazzi G, Tullio A, Zigotti Fuso M, Hayter M, Watson R . Functional Decline in Residents Living in Nursing Homes: A Systematic Review of the Literature. J Am Med Dir Assoc. 2016; 17(8):694-705. DOI: 10.1016/j.jamda.2016.04.002. View

11.

Poss J, Jutan N, Hirdes J, Fries B, Morris J, Teare G . A review of evidence on the reliability and validity of Minimum Data Set data. Healthc Manage Forum. 2008; 21(1):33-9. DOI: 10.1016/S0840-4704(10)60127-5. View

12.

IKEGAMI N, Fries B, Takagi Y, Ikeda S, Ibe T . Applying RUG-III in Japanese long-term care facilities. Gerontologist. 1994; 34(5):628-39. DOI: 10.1093/geront/34.5.628. View

13.

Nguena Nguefack H, Page M, Katz J, Choiniere M, Vanasse A, Dorais M . Trajectory Modelling Techniques Useful to Epidemiological Research: A Comparative Narrative Review of Approaches. Clin Epidemiol. 2020; 12:1205-1222. PMC: 7608582. DOI: 10.2147/CLEP.S265287. View

14.

Gill T, Baker D, Gottschalk M, Peduzzi P, Allore H, Byers A . A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med. 2002; 347(14):1068-74. DOI: 10.1056/NEJMoa020423. View

15.

Sager M, Rudberg M . Functional decline associated with hospitalization for acute illness. Clin Geriatr Med. 1998; 14(4):669-79. View

16.

Fries B, Cooney Jr L . Resource utilization groups. A patient classification system for long-term care. Med Care. 1985; 23(2):110-22. View

17.

Fedecostante M, DellAquila G, Eusebi P, Volpato S, Zuliani G, Abete P . Predictors of Functional Changes in Italian Nursing Home Residents: The U.L.I.S.S.E. Study. J Am Med Dir Assoc. 2015; 17(4):306-11. DOI: 10.1016/j.jamda.2015.11.004. View

18.

Fedecostante M, Onder G, Eusebi P, DellAquila G, Zengarini E, Carrieri B . Predictors of Functional Decline in Nursing Home Residents: The Shelter Project. J Gerontol A Biol Sci Med Sci. 2019; 75(8):1600-1605. DOI: 10.1093/gerona/glz296. View

19.

Stolz E, Gill T, Mayerl H, Rasky E, Freidl W . Trajectories of Late-Life Disability Vary by the Condition Leading to Death. J Gerontol A Biol Sci Med Sci. 2020; 76(7):1260-1264. PMC: 8202147. DOI: 10.1093/gerona/glaa234. View

20.

Bimou C, Harel M, Laubarie-Mouret C, Cardinaud N, Charenton-Blavignac M, Toumi N . Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults. BMC Geriatr. 2021; 21(1):142. PMC: 7908646. DOI: 10.1186/s12877-021-02063-7. View