• OpenAccess
  • Covariates of Disability-Profile Transitions in Older People Living at Home  [CRHC 2014]
  • DOI: 10.4236/jbm.2014.23005   PP.25 - 36
  • Author(s)
  • Michel Raîche, Réjean Hébert, Marie-France Dubois, N’Deye Rokhaya Gueye, Nicole Dubuc
  • The objective of this study was to explore the relationship of sociodemographic, clinical, and health-services use-related variables with transitions between disability-based profiles. In a longitudinal study of 1386 people aged 75 and over living in the community at baseline, disabilities were assessed annually for up to four years with the Functional Autonomy Measurement System (SMAF), which generates 14 Iso-SMAF profiles. These profiles are grouped into 4 disability states, which are predominant alterations in instrumental activities of daily living (IADLs), mobility, mental functions as well as severe and mixed disabilities. Continuous-time, multi-state Markov modeling was used to identify the factors associated with transitions made by older people between these states and to institutionalization and death. Greater age and receiving help for ADL were associated with four transitions, while altered cognitive functions and hospitalization were associated with three, all involving more decline or less recovery. From mild IADL profiles, men have a higher risk of transitioning to intermediate predominantly mental profiles, while women are at higher risk of transitioning to intermediate predominantly mobility profiles. Unmet needs are associated with deterioration, from mild IADL to intermediate predominantly mobility profiles. These results help understanding the complex progression of disabilities in older people.
  • Aged, Disability Profiles, Transitions, Covariates, Multistate Model, Case-Mix Classification, Longitudinal
  • References
  • [1]
    Stineman, M.G., Ross, R.N., Fiedler, R., Granger, C.V. and Maislin, G. (2003) Functional Independence Staging: Conceptual Foundation, Face Validity, and Empirical Derivation. Archives of Physical Medicine Rehabilitation, 84, 29-37.
    St Pierre, M. and Dombi, W.A. (2000) Home Health PPS: New Payment System, New Hope. Caring, 19, 6-11.
    Wieland, D., Lamb, V., Wang, H., Sutton, S., Eleazer, G.P. and Egbert, J. (2000) Participants in the Program of All-Inclusive Care for the Elderly (PACE) Demonstration: Developing Disease-Impairment-Disability Profiles. Gerontologist, 40, 218-227.
    Manton, K.G., Stallard, E. and Corder, L.S. (1998) The Dynamics of Dimensions of Age-Related Disability 1982 to 1994 in the U.S. Elderly Population. Journals of Gerontology Series A: Medical Sciences, 53, B59-B70.
    Dubuc, N., Hébert, R., Desrosiers, J., Buteau, M. and Trottier, L. (2006) Disability-Based Classification System for Older People in Integrated Long-Term Care Services: The Iso-SMAF Profiles. Archives of Gerontology and Geriatrics, 42, 191-206.
    Coutton, V. (2000) The Mechanisms of AGGIR Grid. [Les Mécanismes De La Grille AGGIR.] Convention d’étude No 99/13/0019, Ministère de l’emploi et de la Solidarité, Direction de la Recherche, des études, de l’évaluation et des Statistiques, équipe INSERM, Démographie et Santé. Montpellier, France.
    Morris, J.N., Fries, B.E., Bernabei, R., Steel, K., Ikegami, N., Carpenter, I., Gilgen, R., DuPasquier, J.N., Frijters, D., Henrard, J.C., Hirdes, J. and Belleville-Taylor, P. (1999) RAI Home Care (RAI-HC) Assessment Manual© ; for Version 2.0; Primer on Use of the Minimum Data Set-Home Care (MDS-HC) Version 2.0; and the Client Assessment Protocols (CAPS). Hebrew Rehabilitation Center for Aged. Boston, MA.
    Lafortune, L., Beland, F., Bergman, H. and Ankri, J. (2009) Health State Profiles and Service Utilization in Community-Living Elderly. Medical Care, 47, 286-294.
    Lafortune, L., Beland, F., Bergman, H. and Ankri, J. (2009) Health Status Transitions in Community-Living Elderly with Complex Care Needs: A Latent Class Approach. BMC Geriatrics, 9, 6.
    Raîche, M., Hébert, R., Dubois, M.F., Gueye, N.R. and Dubuc, N. (2012) Yearly Transitions of Disability Profiles in Older People Living at Home. Archives of Gerontology and Geriatrics, 55, 399-405.
    Mor, V., Wilcox, V., Rakowski, W. and Hiris, J. (1994) Functional Transitions among the Elderly: Patterns, Predictors, and Related Hospital Use. American Journal of Public Health, 84, 1274-1280.
    Peres, K., Verret, C., Alioum, A. and Barberger-Gateau, P. (2005) The Disablement Process: Factors Associated with Progression of Disability and Recovery in French Elderly People. Disability and Rehabilitation, 27, 263-276.
    Rudberg, M.A., Parzen, M.I., Leonard, L.A. and Cassel, C.K. (1996) Functional Limitation Pathways and Transitions in Community-Dwelling Older Persons. Gerontologist, 36, 430-440.
    Barberger-Gateau, P., Pérès, K., Lagalaye, L., Nikulin, M., Andrieu, S. and Alioum, A. (2005) Dementia and Functional Decline of older person [Démence et Perte d'autonomie Fonctionnelle du Sujet ?gé]. Revue Medicale Assurance Maladie, 36, 69-76.
    Hébert, R., Brayne, C. and Spiegelhalter, D. (1999) Factors Associated with Functional Decline and Improvement in a Very Elderly Community-Dwelling Population. American Journal of Epidemiology, 150, 501-510.
    Deeg, D.J. (2005) Longitudinal Characterization of Course Types of Functional Limitations. Disability and Rehabilitation, 27, 253-261.
    Beckett, L.A., Brock, D.B., Lemke, J.H., Mendes de Leon, C.F., Guralnik, J.M., Fillenbaum, G.G., Branch, L.G., Wetle, T.T. and Evans, D.A. (1996) Analysis of Change in Self-Reported Physical Function among Older Persons in Four Population Studies. American Journal of Epidemiology, 143, 766-778.
    Dunlop, D.D., Hughes, S.L. and Manheim, L.M. (1997) Disability in Activities of Daily Living: Patterns of Change and a Hierarchy of Disability. American Journal of Public Health, 87, 378-383.
    Ferrucci, L., Guralnik, J.M., Simonsick, E., Salive, M.E., Corti, C. and Langlois, J. (1996) Progressive Versus Catastrophic Disability: A Longitudinal View of the Disablement Process. Journals of Gerontology Series A: Medical Sciences, 51, M123-M130.
    Beland, F. and Zunzunegui, M.V. (1999) Predictors of Functional Status in Older People Living at Home. Age and Ageing, 28, 153-159.
    Van Houwelingen, A.H., Cameron, I.D., Gussekloo, J., Putter, H., Kurrle, S., De Craen, A.J., Maier, A.B., Den Elzen, W.P. and Blom, J.W. (2014) Disability Transitions in the Oldest Old in the General Population. The Leiden 85-Plus Study. Age (Dordr), 36, 483-493.
    Anderson, R.T., James, M.K., Miller, M.E., Worley, A.S. and Longino Jr., C.F. (1998) The Timing of Change: Patterns in Transitions in Functional Status among Elderly Persons. Journals of Gerontology Series B: Social Sciences, 53, S17-S27.
    Mendes de Leon, C.F., Glass, T.A., Beckett, L.A., Seeman, T.E., Evans, D.A. and Berkman, L.F. (1999) Social Networks and Disability Transitions across Eight Intervals of Yearly Data in the New Haven Epese. Journals of Gerontology Series B: Social Sciences, 54, S162-S172.
    Gill, T.M., Robison, J.T. and Tinetti, M.E. (1998) Difficulty and Dependence: Two Components of the Disability Continuum among Community-Living Older Persons. Annals of Internal Medicine, 128, 96-101.
    LaPlante, M.P., Kaye, H.S., Kang, T. and Harrington, C. (2004) Unmet Need for Personal Assistance Services: Estimating the Shortfall in Hours of Help and Adverse Consequences. Journals of Gerontology Series B: Social Sciences, 59, S98-S108.
    Sands, L.P., Xu, H., Craig, B.A., Eng, C. and Covinsky, K.E. (2008) Predicting Change in Functional Status over Quarterly Intervals for Older Adults Enrolled in the PACE Community-Based Long-Term Care Program. Aging Clinical and Experimental Research, 20, 419-427.
    Hébert, R., Raîche, M., Dubois, M.F., Gueye, N.R., Dubuc, N. and Tousignant, M. (2010) Impact of PRISMA, a Coordination-Type Integrated Service Delivery System for Frail Older People in Quebec (Canada): A Quasi-Experimental Study. Journals of Gerontology Series B: Social Sciences, 65B, 107-118.
    Hébert, R., Bravo, G., Korner-Bitensky, N. and Voyer, L. (1996) Predictive Validity of a Postal Questionnaire for Screening Community-Dwelling Elderly Individuals at Risk of Functional Decline. Age Ageing, 25, 159-167.
    Hébert, R., Dubois, M.F., Raîche, M. and Dubuc, N. (2008) The Effectiveness of the PRISMA Integrated Service Delivery Network: Preliminary Report on Methods and Baseline Data. International Journal of Integrated Care, 8, e1- e15.
    Hébert, R., Guilbeault, J., Desrosiers, J. and Dubuc, N. (2001) The Functional Autonomy Measurement System (SMAF): A Clinical-Based Instrument for Measuring Disabilities and Handicaps in Older People. Geriatrics Today: Journal Canadian Geriatric Society, 4, 141-147.
    World Health Organization (1980) International Classification of Impairments, Disabilities, and Handicaps: A Manual of Classification Relating to the Consequences of Disease. WHO.
    Hébert, R., Carrier, R. and Bilodeau, A. (1988) The Functional Autonomy Measurement System (SMAF): Description and Validation of an Instrument for the Measurement of Handicaps. Age and Ageing, 17, 293-302.
    Hébert, R., Spiegelhalter, D.J. and Brayne, C. (1997) Setting the Minimal Metrically Detectable Change on Disability Rating Scales. Archives of Physical Medicine and Rehabilitation, 78, 1305-1308.
    Desrosiers, J., Bravo, G., Hébert, R. and Dubuc, N. (1995) Reliability of the Revised Functional Autonomy Measurement System (SMAF) for Epidemiological Research. Age and Ageing, 24, 402-406.
    Hébert, R., Dubuc, N., Buteau, M., Desrosiers, J., Bravo, G., Trottier, L., St-Hilaire, C. and Roy, C. (2001) Resources and Costs Associated with Disabilities of Elderly People Living at Home and Institutions. Canadian Journal on Aging, 20, 1-21.
    Gervais, P., Hebert, R., Lamontagne, J. and Tousignant, M. (2011) Implementation of Functional Autonomy Measurement System: Barriers and Facilitators in Pise-Dordogne Project. Gériatrie Psychologie Neuropsychiatrie Vieillissement, 9, 417-428.
    Dubuc, N., Corbin, C., Beaudry, M., Delli-Colli, N. and Raiche, M. (2013) Development of Algorithms to Support Decision-Making in Orienting Disabled in the Canton of Geneva's Health-Care System [Développement d’algorithmes de soutien à la décision d’orientation des personnes en perte d’autonomie dans le réseau de soins du Canton de Genève]. Santé Publique, 25, 179-192.
    Giacomin, K.C., Peixoto, S.V., Uchoa, E. and Lima-Costa, M.F. (2008) A Population-Based Study on Factors Associated with Functional Disability among Older Adults in the Great Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Cad Saude Publica, 24, 1260-1270.
    Dubuc, N., Bonin, L., Tourigny, A., Mathieu, L., Couturier, Y., Tousignant, M., Corbin, C., Delli-Colli, N. and Raiche, M. (2013) Development of Integrated Care Pathways: Toward a Care Management System to Meet the Needs of Frail and Disabled Community-Dwelling Older People. International Journal of Integrated Care, 13, e017.
    Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”. A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
    Dubois, M.F., Ra?che, M., Hébert, R. and Gueye, N.R. (2007) Assisted Self-Report of Health-Services Use Showed Excellent Reliability in a Longitudinal Study of Older Adults. Journal of Clinical Epidemiology, 60, 1040-1045.
    Andersen, P.K. (1988) Multistate Models in Survival Analysis: A Study of Nephropathy and Mortality in Diabetes. Statistics in Medicine, 7, 661-670.
    Andersen, P.K., Esbjerg, S. and Sorensen, T.I. (2000) Multi-State Models for Bleeding Episodes and Mortality in Liver Cirrhosis. Statistics in Medicine, 19, 587-599.<587::AID-SIM358>3.3.CO;2-S
    Andersen, P.K. and Keiding, N. (2002) Multi-State Models for Event History Analysis. Statistical Methods in Medical Research, 11, 91-115.
    Commenges, D. (1999) Multi-State Models in Epidemiology. Lifetime Data Analysis, 5, 315-327.
    Gentleman, R.C., Lawless, J.F., Lindsey, J.C. and Yan, P. (1994) Multi-State Markov Models for Analysing Incomplete Disease History Data with Illustrations for Hiv Disease. Statistics in Medicine, 13, 805-821.
    Hougaard, P. (1999) Multi-State Models: A Review. Lifetime Data Analysis, 5, 239-264.
    Jackson, C.H., Sharples, L.D., Thompson, S.G., Duffy, S.W. and Couto, E. (2003) Multistate Markov Models for Disease Progression with Classification Error. Journal of Royal Statis-tical Society, Series D: The Statistician, 52, 1-17.
    Kay, R. (1986) A Markov Model for Analysing Cancer Markers and Disease States in Survival Studies. Biometrics, 42, 855-865.
    Keiding, N., Klein, J.P. and Horowitz, M.M. (2001) Multi-State Models and Outcome Prediction in Bone Marrow Transplantation. Statistics in Medicine, 20, 1871-1885.
    Marshall, G. and Jones, R.H. (1995) Multi-State Models and Diabetic Retinopathy. Statistics in Medicine, 14, 1975- 1983.
    Therneau, T.M. and Grambsch, P.M. (2000) Modeling Survival Data: Extending the Cox Model. Springer-Verlag, New York.
    Jackson, C.H. (2010) Multi-State Modelling with R: The Msm Package. Version 0.9.7.
    Jackson, C.H. (2011) Multi-State Models for Panel Data: The Msm Package for R. Journal of Statistical Software, 38, 1-28.
    Cox, D.R. and Miller, H.D. (1965) The Theory of Stochastic Processes. John Wiley & Sons, New York.
    R Development Core Team (2011) R 2.11.1: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Vienna, Austria.
    LaPlante, M.P. (2010) The Classic Measure of Disability in Activities of Daily Living Is Biased by Age but an Expanded IADL/ADL Measure Is Not. Journals of Gerontology Series B: Social Sciences, 65, 720-732.

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