Predicting 3-year mortality and admission to acute-care hospitals, skilled nursing facilities, and long-term care facilities in Medicare beneficiaries
| Autor: | Pui L. Kwong, Jibby E. Kurichi, Sean Hennessy, Hillary R. Bogner, Dawei Xie, Debra Saliba, Joel E. Streim |
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| Rok vydání: | 2017 |
| Předmět: |
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Aging medicine.medical_specialty Health (social science) Activities of daily living Skilled Nursing Medicare Article 03 medical and health sciences 0302 clinical medicine Surveys and Questionnaires Acute care Activity limitation Activities of Daily Living Humans Medicine Disabled Persons Prospective Studies 030212 general & internal medicine Mortality Prospective cohort study Aged Skilled Nursing Facilities Aged 80 and over Successful aging business.industry 030503 health policy & services Medicare beneficiary medicine.disease Long-Term Care United States Nursing Homes Hospitalization Long-term care Emergency medicine Female Medical emergency Geriatrics and Gerontology 0305 other medical science business Gerontology |
| Zdroj: | Archives of Gerontology and Geriatrics. 73:248-256 |
| ISSN: | 0167-4943 |
| DOI: | 10.1016/j.archger.2017.08.005 |
| Popis: | Purpose The ability to predict mortality and admission to acute care hospitals, skilled nursing facilities (SNFs), and long-term care (LTC) facilities in the elderly and how it varies by activity of daily living (ADL) and instrumental ADL (IADL) status could be useful in measuring the success or failure of economic, social, or health policies aimed at disability prevention and management. We sought to derive and assess the predictive performance of rules to predict 3-year mortality and admission to acute care hospitals, SNFs, and LTC facilities among Medicare beneficiaries with differing ADL and IADL functioning levels. Methods Prospective cohort using Medicare Current Beneficiary Survey data from the 2001 to 2007 entry panels. In all, 23,407 community-dwelling Medicare beneficiaries were included. Multivariable logistic models created predicted probabilities for all-cause mortality and admission to acute care hospitals, SNFs, and LTC facilities, adjusting for sociodemographics, health conditions, impairments, behavior, and function. Results Sixteen, 22, 14, and 14 predictors remained in the final parsimonious model predicting 3-year all-cause mortality, inpatient admission, SNF admission, and LTC facility admission, respectively. The C-statistic for predicting 3-year all-cause mortality, inpatient admission, SNF admission, and LTC facility admission was 0.779, 0.672, 0.753, and 0.826 in the ADL activity limitation stage development cohorts, respectively, and 0.788, 0.669, 0.748, and 0.799 in the ADL activity limitation stage validation cohorts, respectively. Conclusions Parsimonious models can identify elderly Medicare beneficiaries at risk of poor outcomes and can aid policymakers, clinicians, and family members in improving care for older adults and supporting successful aging in the community. |
| Databáze: | OpenAIRE |
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