From the Department of Public Health, College of Health Sciences, Arcadia University, Glenside, Pennsylvania (HFM); and Center for Clinical Epidemiology and Biostatistics (JEK, PLK, DX, HRB), and Departments of Physical Medicine and Rehabilitation (MGS) and Family Medicine and Community Health (HRB), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Published: October 2018
AI Article Synopsis
Article Abstract
Objective: We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes.
Design: This is a cohort study with 21,257 community-dwelling Medicare beneficiaries 65 yrs and older who participated in the 2001-2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β coefficients, which were used to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality for 2 yrs of follow-up.
Results: A total of 18 factors were identified for functional deterioration (P < 0.05). In the derivation cohort, the likelihood of functional deterioration ranged from 6.27% to 33.51%, risk of institutionalization from 0.07% to 12.13%, and risk of mortality from 2.13% to 31.83%, in comparison with stable/improved function.
Conclusions: A risk scoring system predicting Medicare beneficiaries' risk of functional deterioration, institutionalization, and mortality based on demographic and clinical indicators may feasibly be developed with implications for healthcare delivery.
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Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China.
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