Self-perceived met and unmet care needs of frail older adults in primary care

Hoogendijk, Emiel O.; Muntinga, Maaike; Leeuwen, Karen M van; Horst, Henriëtte E. van der; Deeg, Dorly J. H.; Frijters, Dinnus; Hermsen, Lotte A H; Jansen, A.P.D.; Nijpels, Giel; Hout, Hein van

doi:10.1016/j.archger.2013.09.001

Cited by 72 publications

(78 citation statements)

References 38 publications

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“…Although older people often have few unmet needs concerning physical health [31], our findings regarding the importance of mobility for maintaining independence and healthy ageing are supported by previous studies. Preventing and tackling mobility loss is an important part of holistically addressing older people’s problems in various life domains, as mobility deficits are associated with health problems, a decrease in social contacts and a decreased ability to take part in society [48, 49].…”

Section: Discussionsupporting

confidence: 86%

“…As also suggested by earlier studies [31, 45–47], this study highlights that for older people, health and independent living encompasses various health (including physical, cognitive, psychological and social) and environmental domains. Although older people often have few unmet needs concerning physical health [31], our findings regarding the importance of mobility for maintaining independence and healthy ageing are supported by previous studies.…”

Section: Discussionsupporting

confidence: 83%

“…This could imply that there are unmet care needs that fall within, for instance, the psychological, social and environmental domains of life (e.g. company, daytime activities, access to information) [30, 31]. Furthermore, as more recent studies have already suggested, older people tend to value a multidimensional and person-centred approach, and would appreciate more alignment between initiatives and their needs and preferences [30–34].…”

Section: Introductionmentioning

confidence: 99%

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Improving early detection initiatives: a qualitative study exploring perspectives of older people and professionals

et al. 2017

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BackgroundA wide range of initiatives on early detection and intervention have been developed to proactively identify problems related to health and wellbeing in (frail) older people, with the aim of supporting them to live independently for as long as possible. Nevertheless, it remains unclear what the best way is to design such initiatives and how older people’s needs and preferences can be best addressed. This study aimed to address this gap in the literature by exploring: 1) older people’s perspectives on health and living environment in relation to living independently at home; 2) older people’s needs and preferences in relation to initiating and receiving care and support; and 3) professionals’ views on what would be necessary to enable the alignment of early detection initiatives with older people’s own needs and preferences.MethodsIn this qualitative study, we conducted semi-structured interviews with 36 older people and 19 professionals in proactive elderly care. Data were analysed using the framework analysis method.ResultsFrom the interviews with older people important themes in relation to health and living environment emerged, such as maintaining independence, appropriate housing, social relationships, a supporting network and a sense of purpose and autonomy. Older people preferred to remain self-sufficient, and they would rather not ask for help for psychological or social problems. However, the interviews also highlighted that they were not always able or willing to anticipate future needs, which can hinder early detection or early intervention. At the same time, professionals indicated that older people tend to over-estimate their self-reliance and therefore advocated for early detection and intervention, including social and psychological issues.ConclusionOlder people have a broad range of needs in different domains of life. Discrepancies exist between older people and professionals with regard to their views on timing and scope of early detection initiatives. This study aimed to reveal starting-points for better alignment between initiatives and older people’s needs and preferences. Such starting points may support policy makers and care professionals involved in early detection initiatives to make more informed decisions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0521-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Improving early detection initiatives: a qualitative study exploring perspectives of older people and professionals

et al. 2017

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“…Older people want to stay independent and live in their homes and communities until old age (Gillsjö, Schwartz‐Barcott, & von Post, ; Wiles, Leibing, Guberman, Reeve, & Allen, ). As the prevalence of multiple chronic conditions and disability increases with age, older people who live at home may suffer from limitations in the physical, cognitive, psychological, social and/or environmental domains of life (Hoogendijk et al, ; Lette et al, ). These limitations may challenge older people's social participation and independent living, and result in complex health and social care needs.…”

Section: Introductionmentioning

confidence: 99%

“…Through providing a uniform process for assessing needs, a CGA may promote shared understanding of older people's needs, common professional language and agreed‐upon practices and standards, which are considered essential ingredients in integrated care (Kodner & Spreeuwenberg, ). A CGA helps health and social care professionals to understand problems and care needs older people experience, so that services professionals provide are matched to the needs and preferences of the people they serve (Hoogendijk et al, ; Stijnen, Duimel‐Peeters, Jansen, & Vrijhoef, ). Also for older people themselves, it is important to understand and acknowledge their (unmet) care needs, as this is expected to increase their involvement in and control over their care and support.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Stoop

Lette

Gils

et al. 2019

Health Soc Care Community

Self Cite

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In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.

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Adaptation of the Risk Analysis Index for Frailty Assessment Using Diagnostic Codes

Dicpinigaitis,

Khamzina,

Hall

et al. 2024

JAMA Netw Open

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ImportanceFrailty is associated with adverse outcomes after even minor physiologic stressors. The validated Risk Analysis Index (RAI) quantifies frailty; however, existing methods limit application to in-person interview (clinical RAI) and quality improvement datasets (administrative RAI).ObjectiveTo expand the utility of the RAI utility to available International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) administrative data, using the National Inpatient Sample (NIS).Design, Setting, and ParticipantsRAI parameters were systematically adapted to ICD-10-CM codes (RAI-ICD) and were derived (NIS 2019) and validated (NIS 2020). The primary analysis included survey-weighed discharge data among adults undergoing major surgical procedures. Additional external validation occurred by including all operative and nonoperative hospitalizations in the NIS (2020) and in a multihospital health care system (UPMC, 2021-2022). Data analysis was conducted from January to May 2023.ExposuresRAI parameters and in-hospital mortality.Main Outcomes and MeasuresThe association of RAI parameters with in-hospital mortality was calculated and weighted using logistic regression, generating an integerized RAI-ICD score. After initial validation, thresholds defining categories of frailty were selected by a full complement of test statistics. Rates of elective admission, length of stay, hospital charges, and in-hospital mortality were compared across frailty categories. C statistics estimated model discrimination.ResultsRAI-ICD parameters were weighted in the 9 548 206 patients who were hospitalized (mean [SE] age, 55.4 (0.1) years; 3 742 330 male [weighted percentage, 39.2%] and 5 804 431 female [weighted percentage, 60.8%]), modeling in-hospital mortality (2.1%; 95% CI, 2.1%-2.2%) with excellent derivation discrimination (C statistic, 0.810; 95% CI, 0.808-0.813). The 11 RAI-ICD parameters were adapted to 323 ICD-10-CM codes. The operative validation population of 8 113 950 patients (mean [SE] age, 54.4 (0.1) years; 3 148 273 male [weighted percentage, 38.8%] and 4 965 737 female [weighted percentage, 61.2%]; in-hospital mortality, 2.5% [95% CI, 2.4%-2.5%]) mirrored the derivation population. In validation, the weighted and integerized RAI-ICD yielded good to excellent discrimination in the NIS operative sample (C statistic, 0.784; 95% CI, 0.782-0.786), NIS operative and nonoperative sample (C statistic, 0.778; 95% CI, 0.777-0.779), and the UPMC operative and nonoperative sample (C statistic, 0.860; 95% CI, 0.857-0.862). Thresholds defining robust (RAI-ICD &lt;27), normal (RAI-ICD, 27-35), frail (RAI-ICD, 36-45), and very frail (RAI-ICD &gt;45) strata of frailty maximized precision (F1 = 0.33) and sensitivity and specificity (Matthews correlation coefficient = 0.26). Adverse outcomes increased with increasing frailty.Conclusion and RelevanceIn this cohort study of hospitalized adults, the RAI-ICD was rigorously adapted, derived, and validated. These findings suggest that the RAI-ICD can extend the quantification of frailty to inpatient adult ICD-10-CM–coded patient care datasets.

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Self-perceived met and unmet care needs of frail older adults in primary care

Cited by 72 publications

References 38 publications

Improving early detection initiatives: a qualitative study exploring perspectives of older people and professionals

Improving early detection initiatives: a qualitative study exploring perspectives of older people and professionals

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Adaptation of the Risk Analysis Index for Frailty Assessment Using Diagnostic Codes

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