TITLE:
Covariates of Disability-Profile Transitions in Older People Living at Home
AUTHORS:
Michel Raîche, Réjean Hébert, Marie-France Dubois, N’Deye Rokhaya Gueye, Nicole Dubuc
KEYWORDS:
Aged, Disability Profiles, Transitions, Covariates, Multistate Model, Case-Mix Classification, Longitudinal
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.2 No.3,
May
12,
2014
ABSTRACT: The objective of this study was to explore the relationship of sociodemographic, clinical, and health-services use-related variables with transitions between disability-based profiles. In a longitudinal study of 1386 people aged 75 and over living in the community at baseline, disabilities were assessed annually for up to four years with the Functional Autonomy Measurement System (SMAF), which generates 14 Iso-SMAF profiles. These profiles are grouped into 4 disability states, which are predominant alterations in instrumental activities of daily living (IADLs), mobility, mental functions as well as severe and mixed disabilities. Continuous-time, multi-state Markov modeling was used to identify the factors associated with transitions made by older people between these states and to institutionalization and death. Greater age and receiving help for ADL were associated with four transitions, while altered cognitive functions and hospitalization were associated with three, all involving more decline or less recovery. From mild IADL profiles, men have a higher risk of transitioning to intermediate predominantly mental profiles, while women are at higher risk of transitioning to intermediate predominantly mobility profiles. Unmet needs are associated with deterioration, from mild IADL to intermediate predominantly mobility profiles. These results help understanding the complex progression of disabilities in older people.