Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial

Richardson, Julie; Chan, David W.; Risdon, Kathy; Giles, Christopher; Mulveney, Susan; Cripps, Donna

doi:10.1177/0269215508095090

Cited by 11 publications

(23 citation statements)

References 21 publications

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“…The review encompassed a broad range of community‐dwelling older adult populations and any outpatient multifactorial assessment and management interventions that could prevent functional decline or improve functional ability (Table ). Twenty‐four of the 70 trials included unselected or general‐risk populations . Although the majority of trials targeted older adults “at risk” for functional decline, high‐risk designations were based on widely varying criteria: primary care physician identification as high risk, recently hospitalized, recently in the emergency department, recent fall or at high fall risk, screened positive for risk of functional decline or hospitalization, high healthcare users, low income, minimally care assisted, multiple chronic health conditions, frail seniors, mild dementia, and other multifaceted approaches .…”

Section: Resultsmentioning

confidence: 99%

“…Restricting analyses to similar risk populations or more‐similar interventions substantially limited the number of trials included in the analyses without significantly affecting pooled results or reducing statistical heterogeneity. For example, of the 17 trials included in the ADL and IADL meta‐analyses, only four evaluated comprehensive multifactorial assessment and management interventions in older adults at risk of functional decline, and only three trials evaluated less‐comprehensive interventions in unselected older adults . Likewise, only six trials of comprehensive interventions in at‐risk adults and two in less‐comprehensive interventions in unselected adults were included in the meta‐analyses for hospitalization outcomes (total 16 trials).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-four of the 70 trials included unselected or general-risk populations. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although the majority of trials targeted older adults "at risk" for functional decline, high-risk designations were based on widely varying criteria: primary care physician identification as high risk, [30][31][32] recently hospitalized, [33][34][35] recently in the emergency department, 36,37 recent fall or at high fall risk, [38][39][40][41][42][43][44][45][46][47][48][49][50][51] screened positive for risk of functional decline or hospitalization, 5,52-59 high healthcare users, 60,61 low income, 62 minimally care assisted, 63,64 multiple chronic health conditions, 65 frail seniors, [66][67][68][69][70][71] mild dementia, 72 a...…”

Section: Challenges In Understanding Population Risk and Complex Intementioning

confidence: 99%

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Challenges in Synthesizing and Interpreting the Evidence from a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults

Lin

Whitlock

Eckstrom

et al. 2012

J American Geriatrics Society

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A systematic review of multifactorial assessment and management interventions to prevent functional decline in older adults was undertaken for the U.S. Preventive Services Task Force. It was not possible to determine net benefit because of heterogeneity of studies, including how older adults were selected and their risk of functional decline; the broad spectrum and multifactorial nature of interventions evaluated; the suboptimal and inconsistent use of outcomes measured; and the inconsistent and inadequate reporting of data that might allow comparison of populations, interventions, and outcomes between studies. This review process illustrated the complexities encountered when synthesizing and interpreting the evidence in geriatric research and methods of reviewing complex interventions and multiple interrelated health outcomes. This article summarizes the review findings, focusing on methodological challenges, and offers suggestions to researchers on the design, reporting, and analysis of trials that would help address these challenges and allow for better interpretation of evidence in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Challenges In Understanding Population Risk and Complex Intementioning

confidence: 99%

See 1 more Smart Citation

Challenges in Synthesizing and Interpreting the Evidence from a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults

Lin

Whitlock

Eckstrom

et al. 2012

J American Geriatrics Society

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“…(63) Yet another limitation may be that we did not include a non-caregiver control group with whom to compare changes in HRQOL over time. However, published results of non-caregiving community-dwelling older adults (65, 66) indicate that HRQOL remains stable over time, and shows little variability, particularly over a one year period. Thus, we believe that our findings regarding the decline in physical health and pain over the first year post-transplant are more likely due to caregiving demands rather than a function of normative changes over time.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Outcomes of Health-Related Quality of Life in Caregivers of Cardiothoracic Transplant Recipients

Myaskovsky

Posluszny

Schulz

et al. 2012

American Journal of Transplantation

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Cardiothoracic transplant programs generally require that transplant recipients have family caregivers to assist them post-transplant. The burden of caregiving on the family members remains poorly understood. If caregivers’ well-being is compromised by caregiving, it may bode poorly for transplant recipients’ own health in the long-term post-transplant. We examined caregiver HRQOL during the first year after their family member’s transplant, its predictors, and its relationship to subsequent patient survival. Adult (aged 18+) caregivers of 242 cardiothoracic transplant recipients (lung=134; heart=108) completed assessments of demographics, psychosocial characteristics, and caregiver burden at 2 months post-transplant, and HRQOL at 2, 7 and 12 months post-transplant. Recipients’ survival time was obtained from medical records. Caregiver HRQOL was generally high across the first year post-transplant in emotional and social functioning; caregiver physical functioning significantly worsened. There were no differences by type of recipient transplant. Greater caregiver burden predicted poorer caregiver HRQOL in several physical domains at 12 months post-transplant. Transplant recipients whose caregivers had lower perceived general health at 12 months post-transplant showed poorer survival rates during the subsequent 7 years of follow-up. Transplant teams should identify those caregivers at risk for poorer general health post-transplant in order to maximize positive outcomes for the entire family.

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“…Increased interest in the maintenance of function and prevention of disability has led to relatively new diagnostic criteria, such as symptoms of frailty or preclinical disability. The utility of identifying individuals who are 'high risk' for future functional decline rests on the notion that it is potentially an easier state to reverse than overt disability [3]. Intervention programs designed to prevent functional decline in older adults show that participants with relatively good functional status or moderate frailty are those who benefit the most from these programs [4].…”

Section: Introductionmentioning

confidence: 99%

Calibrating ADL-IADL scales to improve measurement accuracy and to extend the disability construct into the preclinical range: a systematic review

et al. 2011

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BackgroundInterest in measuring functional status among nondisabled older adults has increased in recent years. This is, in part, due to the notion that adults identified as 'high risk' for functional decline portray a state that is potentially easier to reverse than overt disability. Assessing relatively healthy older adults with traditional self-report measures (activities of daily living) has proven difficult because these instruments were initially developed for institutionalised older adults. Perhaps less evident, are problems associated with change scores and the potential for 'construct under-representation', which reflects the exclusion of important features of the construct (e.g., disability). Furthermore, establishing a formal hierarchy of functional status tells more than the typical simple summation of functional loss, and may have predictive value to the clinician monitoring older adults: if the sequence task difficulty is accelerated or out of order it may indicate the need for interventions.MethodsThis review identified studies that employed item response theory (IRT) to examine or revise functional status scales. IRT can be used to transform the ordinal nature of functional status scales to interval level data, which serves to increase diagnostic precision and sensitivity to clinical change. Furthermore, IRT can be used to rank items unequivocally along a hierarchy based on difficulty. It should be noted that this review is not concerned with contrasting IRT with more traditional classical test theory methodology.ResultsA systematic search of four databases (PubMed, Embase, CINAHL, and PsychInfo) resulted in the review of 2,192 manuscripts. Of these manuscripts, twelve met our inclusion/exclusion requirements and thus were targeted for further inspection.ConclusionsManuscripts presented in this review appear to summarise gerontology's best efforts to improve construct validity and content validity (i.e., ceiling effects) for scales measuring the early stages of activity restriction in community-dwelling older adults. Several scales in this review were exceptional at reducing ceiling effects, reducing gaps in coverage along the construct, as well as establishing a formal hierarchy of functional decline. These instrument modifications make it plausible to detect minor changes in difficulty for IADL items positioned at the edge of the disability continuum, which can be used to signal the onset of progressive type disability in older adults.

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Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial

Abstract: Providing information about the results of detailed assessment of physical functioning to older adults and their physicians did not show significant differences in function scores between the intervention and control groups.

Cited by 11 publications

References 21 publications

Challenges in Synthesizing and Interpreting the Evidence from a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults

Challenges in Synthesizing and Interpreting the Evidence from a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults

Predictors and Outcomes of Health-Related Quality of Life in Caregivers of Cardiothoracic Transplant Recipients

Calibrating ADL-IADL scales to improve measurement accuracy and to extend the disability construct into the preclinical range: a systematic review

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