Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults

BMC Geriatrics

Justine Trimouillas¹  Caroline Gayot¹  Nassima Toumi²  Cécile Laubarie-Mouret²  Noëlle Cardinaud³  Thierry Dantoine³  Marion Charenton-Blavignac³  Sophie Boyer⁴  Achille Tchalla⁴  Charlotte Bimou⁵  Michel Harel⁶  Réjean Hebert⁷ 

[1] CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France;CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France;Unité de Recherche Clinique et de l’Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France;CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France;Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France;CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France;Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France;Unité de Recherche Clinique et de l’Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France;CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France;Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France;Unité de Recherche Clinique et de l’Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France;HAVAE Laboratory, University of Limoges, 123 avenue Albert Thomas, F-87060, Limoges, France;Institut de Mathématiques de Toulouse et École Supérieure du Professorat et de l’Éducation à l’Université de Limoges, 87000, Limoges, France;Université de Montreal, Québec, Canada;

关键词: Independence;    Functional decline;    Prevention;    Trajectory;    Older adults;    Semi-parametric model;    Optimal number of groups;   

DOI  :  10.1186/s12877-021-02063-7

来源: Springer

【 摘 要 】

BackgroundIndependence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies.MethodsIndependence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory.ResultsThree distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD.ConclusionsCommunity-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

【 授权许可】

CC BY