Predicting 3-year mortality and admission to acute-care hospitals, skilled nursing facilities, and long-term care facilities in Medicare beneficiaries

Abstract

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 2001–2007 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.

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

“…20,21 People with higher levels of physical dependency and limitation may need to be admitted to LTC facilities because of their increased care burden and have a higher risk of death when incapacity becomes too severe. of the resource allocation process, because it can help focus policy attention on the key factors that can prolong living at home and extend life in the community.…”

“…From the overall score, an individual is categorised as maximum dependency (0-5), high dependency (6-10), medium dependency (11)(12)(13)(14)(15), low dependency (16)(17)(18)(19), and independent (20). Physical dependency level was assessed using the Barthel index (BI), a simple index based on the scoring of 10 items.…”

“…There is evidence that reduced activities of daily living (ADL) activity is associated with functional deterioration, LTC, and mortality among older people. 20,21 People with higher levels of physical dependency and limitation may need to be admitted to LTC facilities because of their increased care burden and have a higher risk of death when incapacity becomes too severe. 20 In a systematic review and meta-analysis, Cepoiu-Martin et al found that increased age, functional impairment, behavioural, and psychological problems and being in the severe stages of dementia were significant predictors of LTC placement for people with dementia.…”

“…20,21 People with higher levels of physical dependency and limitation may need to be admitted to LTC facilities because of their increased care burden and have a higher risk of death when incapacity becomes too severe. 20 In a systematic review and meta-analysis, Cepoiu-Martin et al found that increased age, functional impairment, behavioural, and psychological problems and being in the severe stages of dementia were significant predictors of LTC placement for people with dementia. 22 The older population in receipt of home support represent a vulnerable subgroup, characterised by a high prevalence of "cognitive dysfunction" (46%) and frailty (41%).…”

“…Its main aim is to establish the degree to which a person is independent from needing any help, physical or verbal, with these items however minor and for whatever reason. From the overall score, an individual is categorised as maximum dependency (0-5), high dependency (6-10), medium dependency (11)(12)(13)(14)(15), low dependency (16)(17)(18)(19), and independent (20). 26 Assistance with mobility and feeding (two of 10 items on the BI), falls risk (documented on CSAR form), and assistance with meal preparation (documented on care plan) were recorded as binary variables.…”