Assessment of Functioning in Older Adults Hospitalized in Long-Term Care in Portugal: Analysis of a Big Data

Abstract

BackgroundFunctioning assessment is a key tool for health professionals to characterize the person's degree of dependence and plan care.ObjectivesThe objectives were: (1) know the functioning components of older adults hospitalized in the National Network of Continuous Integrated Health Care (NNCIHC) in Portugal; and (2) compare the conceptual frameworks used in this network with the International Classification of Functioning, Disability and Health (ICF).MethodsA longitudinal retrospective study is made with 171,414 individuals aged 65 years and over. The Principal Components Analysis (PCA) was realized to reduce the number of variables, previously suggested by a scoping review, about the concepts that characterize the functionality. Then, a consensus meeting was held, where the items were matched with the ICF.ResultsThe average age of the sample is 80.17 years old (SD = 7.383), predominantly female (59%), without a spouse (54%), and with <6 years of education (56.4%). Four concepts were grouped: mobility, life daily activities, instrumental activities, and cognitive status that demonstrated good internal consistency. Most items correspond to ICF, except for the item “taking medication.”ConclusionTheoretical and conceptual similarities support the use of instruments based on the ICF in Portugal's healthcare network. We suggest that ICF also encompasses a specific dimension related to medication management, given its importance for people's health.

A rapid literature review on the health-related outcomes of long-term person-centered care models in adults with chronic illness

“…Self-rated health and global deterioration; 2 Anxiety, depression, self-care and the effect of illness on life; 3 Delusions, hallucinations, agitation, dysphoria, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, night-time behavior disturbances, mood, behavioral changes, and eating abnormalities; 4 Exercise capacity, physical capacity and physical-related health outcomes; 5 Nurse consultations, primary care physician consultations, staff and patient interactions; 6 Vocational and methodological expertise, social competence and self-competence; 7 Burnout and work-related stress; the employment of patient-centered care reported a direct association with empowerment for self-care (28), while another highlighted the absence of significant associations. Data on the psychosocial wellbeing of the staff showed inconsistent results in the same study, according to the assessed dimension (31).…”

“…However, the state of greater vulnerability, the occurrence of pathological processes and thus the decreases in a person’s functionality and independence hinders his or her ability to perform self-care, requiring adaptations on the part of the health sectors and at the social level ( 3 , 4 , 10 ). Thus, there is an emerging need to respond to an imbalance between the provision of care to dependent persons and their ability to care for themselves; thus, many older adults and their families turn to long-term care institutions to guarantee necessary care ( 5 ).…”

“…Self-care is one of the most important dimensions of the health and well-being of populations (1). Thus, collecting data that facilitate a functional diagnosis or a diagnosis of self-care dependence is essential in developing an individual care plan that, in the mediumand long-term, can translate into health gains (2)(3)(4)(5).…”

Long-term care units: a Portuguese study about the functional profile

“…To assure the validity and fidelity of the self-care variables and functional capacity items analysis of the main components were performed to Mobility (KMO = .743; p < .000); Activities of Daily Living (KMO = .885; p < .000); Instrumental Activities of Daily Living (KMO = .917; p < .000); Cognitive State (KMO = .593; p < .000) and Cronbach’s Alpha of α = 0.951 ( Ramos et al, 2022 ), and all the outputs show excellent internal consistency. A high correlation was verified among the items constituting the Instrumental Activities of Daily Living.…”

“…Care is provided 24 h a day, 7 days a week ( Pereira et al, 2021 ). Based on the objectives of long-term care units, assessing their functionality is important to assessing health outcomes ( Maresova et al, 2019 ; Ramos et al, 2022 ). The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) to standardize the assessment of international functioning and disability related to the disease process, considering the structures and functions of the body and environmental factors ( World Health Organization, 2001 ).…”