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J Am Geriatr Soc. 2018 Aug;66(8):1587-1591. doi: 10.1111/jgs.15399. Epub 2018 May 2.

Prognostic Effect of Changes in Physical Function Over Prior Year on Subsequent Mortality and Long-Term Nursing Home Admission.

Author information

1
Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut.

Abstract

OBJECTIVES:

To evaluate the prognostic effect of changes in physical function at different intervals over the prior year on subsequent outcomes after accounting for present function.

DESIGN:

Prospective longitudinal study.

SETTING:

Greater New Haven, Connecticut, from March 1998 to January 2006.

PARTICIPANTS:

Community-living persons aged 71 and older who completed an 18-month comprehensive assessment (N=658).

MEASUREMENTS:

Disability in 13 activities of daily living, instrumental activities of daily living, and mobility activities was assessed at the 18-month comprehensive assessment and at 12, 6, and 3 months before 18 months. Time to death and long-term nursing home admission, defined as 3 months and longer, were ascertained for up to 5 years after 18 months.

RESULTS:

In the bivariate models, disability at 18 months and change in disability between 18 months and each of the 3 prior time-points (12, 6, 3 months) were significantly associated with time to death. The risk of death, for example, increased by 24% for each 1-point increase in 18-month disability score (on a scale from 0 to 13) and by 22% for each 1-point change in disability score between 18 months and prior 12 months (on a scale from -13 to 13). In a set of multivariable models with and without covariates, the associations were maintained for 18-month disability but not for change in disability between 18 months and each of the 3 prior time-points. The results were comparable for time to long-term nursing home admission except that 2 of the associations were not statistically significant.

CONCLUSION:

When evaluating risk of adverse outcomes, such as death and long-term nursing home admission, an assessment of change in physical function at different intervals over the prior year, although a strong bivariate predictor, did not provide useful prognostic information beyond that available from current level of function.

KEYWORDS:

disability; longitudinal study; older persons; prognosis

PMID:
29719039
PMCID:
PMC6133765
[Available on 2019-08-01]
DOI:
10.1111/jgs.15399

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