Natural course of care dependency in residents of long-term care facilities: prospective follow-up study

BMC Geriatrics

Jacobijn Gussekloo¹  Herman JM Cools¹  Monique AA Caljouw¹ 

[1] Department of Public Health and Primary Care, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, the Netherlands

关键词: Vulnerable older persons;    Long-term care facility;    Mortality;    Variability;    Predictive factors;    Care dependency;   

Others  :  854716
DOI  :  10.1186/1471-2318-14-67

 received in 2013-10-09, accepted in 2014-05-14,  发布年份 2014

【 摘 要 】

Background

Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality.

Methods

A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79–88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15–75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months.

Results

At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P < 0.001); participants in the low CDS group stayed longer, had more frequent urine incontinence and more dementia. They had also the highest mortality rate (log rank 32.2; df = 2; P for trend <0.001). Per point lower in CDS score, the mortality risk increased with 2% (95% CI 1%-3%). Adjustment for age, gender, cranberry use, LTCF, length of stay, comorbidity and dementia showed similar results. A one point decrease in CDS score between 0 and 6 months was related to an increased mortality risk of 4% (95% CI 3%-6%).

At the 6-month follow-up, 10% improved to a higher CDS group, 65% were in the same, and 25% had deteriorated to a lower CDS group; a similar pattern emerged at 12-month follow-up. Gender, age, urine incontinence, dementia, cancer and baseline care dependency status, predicted an increase in care dependency over time.

Conclusion

The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

【 授权许可】

   
2014 Caljouw et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Christensen K, Doblhammer G, Rau R, Vaupel JW: Ageing populations: the challenges ahead. Lancet 2009, 374:1196-1208.
• [2]Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004, 59:255-263.
• [3]Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC: Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc 2008, 56:68-75.
• [4]Dutch Central Bureau for Statistics (CBS)http://statline.cds.nl webcite
• [5]de Klerk M: Zorg in de laatste jaren. Gezondheid en hulpgebruik in verzorgings- en verpleeghuizen 2000–2008. [Care in the last years. Health and care use in residential homes and nursing homes 2000–2008]. The Hague: Sociaal Cultureel Planbureau; 2011.
• [6]Conroy S, Van Der Cammen T, Schols J, Van Balen R, Peteroff P, Luxton T: Medical services for older people in nursing homes–comparing services in England and the Netherlands. J Nutr Health Aging 2009, 13:559-563.
• [7]Orem DF: Nursing: Concepts of Practice. New York: McGraw-Hill; 2012.
• [8]Gill TM, Gahbauer EA, Han L, Allore HG: Trajectories of disability in the last year of life. N Engl J Med 2010, 362:1173-1180.
• [9]Chen JH, Chan DC, Kiely DK, Morris JN, Mitchell SL: Terminal trajectories of functional decline in the long-term care setting. J Gerontol A Biol Sci Med Sci 2007, 62:531-536.
• [10]Guilley E, Ghisletta P, Armi F, Berchtold A, Lalive d’Epinay C, Michel J-P, de Ribeaupierre A: Dynamics of frailty and ADL dependence in a five-year logitudinal study of octogenerians. Research on Aging 2008, 30:299-317.
• [11]Lohrmann C, Dijkstra A, Dassen T: Care dependency: testing the German version of the Care Dependency Scale in nursing homes and on geriatric wards. Scand J Caring Sci 2003, 17:51-56.
• [12]Bürge E, von Gunten A, Berchtold A: Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: a survival analysis. Arch Gerontol Geriatr 2013, 56:250-257.
• [13]Buttar A, Blaum C, Fries B: Clinical characteristics and six-month outcomes of nursing home residents with low activities of daily living dependency. J Gerontol A Biol Sci Med Sci 2001, 56:M292-M297.
• [14]Dijkstra A, Sipsma D, Dassen T: Predictors of care dependency in Alzheimer’s disease after a two-year period. Int J Nurs Stud 1999, 36:487-495.
• [15]Carpenter GI, Hastie CL, Morris JN, Fries BE, Ankri J: Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment. BMC Geriatr 2006, 6:7. BioMed Central Full Text
• [16]Phillips LJ, Rantz M, Petroski GF: Indicators of a new depression diagnosis in nursing home residents. J Gerontol Nurs 2011, 37:42-52.
• [17]Sarazin M, Stern Y, Berr C, Riba A, Albert M, Brandt J, Dubois B: Neuropsychological predictors of dependency in patients with Alzheimer’s disease. Neurology 2005, 64:1027-1031.
• [18]Wang J, Kane RL, Eberly LE, Virnig BA, Chang LH: The effects of resident and nursing home characteristics on activities of daily living. J Gerontol A Biol Sci Med Sci 2009, 64:473-480.
• [19]Caljouw MA, Kruijdenberg SJ, de Craen AJ, Cools HJ, den Elzen WP, Gussekloo J: Clinically diagnosed infections predict disability in activities of daily living among the oldest-old in the general population: the Leiden 85-plus Study. Age Ageing 2013, 42:482-488.
• [20]Caljouw MA, van den Hout WB, Putter H, Achterberg WP, Cools HJM, Gussekloo J: Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons. A double-blind randomized placebo-controlled trial in long-term care facilities. J Am Geriatr Soc 2014, 62:103-110.
• [21]Dijkstra A, Brown L, Havens B, Romeren TI, Zanotti R, Dassen TW, Vand en Heuvel W: An international psychometric testing of the care dependency scale. J Adv Nurs 2000, 31:944-952.
• [22]Dijkstra A, Tiesinga LJ, Plantinga L, Veltman G, Dassen TW: Diagnostic accuracy of the care dependency scale. J Adv Nurs 2005, 50:410-416.
• [23]Dijkstra A, Tiesinga LJ, Goossen WT, Dassen TW: Further psychometric testing of the Dutch Care Dependency Scale on two different patient groups. Int J Nurs Pract 2002, 8:305-314.
• [24]Janssen DJ, Wouters EF, Schols JM, Spruit MA: Care dependency independently predicts two-year survival in outpatients with advanced chronic organ failure. J Am Med Dir Assoc 2013, 14:194-198.
• [25]Marengoni A, Von SE, Rizzuto D, Winblad B, Fratiglioni L: The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med 2009, 265:288-295.
• [26]Chen LK, Peng LN, Lin MH, Lai HY, Hwang SJ, Lan CF: Predicting mortality of older residents in long-term care facilities: comorbidity or care problems? J Am Med Dir Assoc 2010, 11:567-571.
• [27]Ferrucci L, Guralnik JM, Simonsick E, Salive ME, Corti C, Langlois J: Progressive versus catastrophic disability: a longitudinal view of the disablement process. J Gerontol A Biol Sci Med Sci 1996, 51:M123-M130.
• [28]Dijkstra A, Yont GH, Korhan EA, Muszalik M, Kedziora-Kornatowska K, Suzuki M: The Care Dependency Scale for measuring basic human needs: an international comparison. J Adv Nurs 2012, 68:2341-2348.
• [29]Mahoney FI, Barthel DW: Functional evaluation: the Barthel index. Md State Med J 1965, 14:61-65.
• [30]Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963, 185:914-919.
• [31]Hjaltadottir I, Hallberg IR, Ekwall AK, Nyberg P: Predicting mortality of residents at admission to nursing home: a longitudinal cohort study. BMC Health Serv Res 2011, 11:86. BioMed Central Full Text