Factors associated with healthcare utilization and trajectories in retirement village residents.
hospitalizations
independent living
long-term care
mortality
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
revised:
01
11
2021
received:
10
06
2021
accepted:
17
11
2021
pubmed:
16
12
2021
medline:
4
5
2022
entrez:
15
12
2021
Statut:
ppublish
Résumé
To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities. Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ). InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs). time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up. Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001). A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
Sections du résumé
BACKGROUND
To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities.
METHODS
Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ).
MEASUREMENT
InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs).
OUTCOMES
time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up.
RESULTS
Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001).
CONCLUSION
A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
754-765Informations de copyright
© 2021 The American Geriatrics Society.
Références
Cutchin MP. The process of mediated aging-in-place: a theoretically and empirically based model. Soc Sci Med. 2003;57(6):1077-1090.
Broad JB, Boyd M, Kerse N, et al. Residential aged care in Auckland, New Zealand 1988-2008: do real trends over time match predictions? Age Ageing. 2011;40:487-494.
Boyd M, Broad JB, Kerse N, et al. Twenty-year trends in dependency in residential aged care in Auckland, NZ: a descriptive study. J Am Med Dir Assoc. 2011;12(7):535-540.
Jones Lang LaSallle. NZ retirement villages and aged care. Whitepaper. New Zealand Retirement Village Database (NZRVD) and Aged Care Database (NZACD) Year ending 2019. Jones Lang La Salle IP Inc; June 2020.
Broad JB, Ashton T, Gott M, McLeod H, Davis PB, Connolly MJ. Likelihood of residential aged care use in later life: a simple approach to estimation, with international comparison. Aust N Z J Public Health. 2015;39(4):374-379.
Broad JB, Wu Z, Bloomfield K, et al. Health profile of residents of retirement villages in Auckland, New Zealand: findings from a cross-sectional survey with health assessment. BMJ Open. 2020;10(9):e035876.
Boyd M, Calvert C, Tatton A, et al. Lonely in a crowd: loneliness in New Zealand retirement village residents. Int Pyshcogeriatr. 2020 Apr;15:1-13. doi:10.1017/S104160220000393
Crisp DA, Windsor TD, Anstey KJ, Butterworth P. What are older adults seeking? Factors encouraging or discouraging retirement village living. Australas J Ageing. 2013;32(3):163-170.
Peri K, Broad JB, Hikaka J, et al. Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary intervention designed to avoid adverse outcomes. BMC Geriatr. 2020;20(1):247.
Connolly MJ, Broad JB, Boyd M, et al. The 'Big Five'. Hypothesis generation: a multidisciplinary intervention package reduces disease-specific hospitalisations from long-term care: a post hoc analysis of the ARCHUS cluster-randomised controlled trial. Age Ageing. 2016;45(3):415-420.
Connolly MJ, Broad JB, Bish T, et al. Reducing emergency presentations from long-term care: a before-and-after study of a multidisciplinary team intervention. Maturitas. 2018;117:45-50.
Bloomfield K, Wu Z, Broad JB, et al. Learning from a multidisciplinary randomized intervention in retirement village residents. J Am Geriatr Soc. 2022;70(3):743-753. doi:10.1111/jgs.17533
Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31-S34.
Cheung G, Clugston A, Croucher M, et al. Performance of three cognitive screening tools in a sample of older New Zealanders. Int Psychogeriatr. 2015 June;27(6):981-989.
Hirdes JP, Ljunggren G, Morris JN, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277. doi:10.1186/1472-6963-8-277-288
Gray LC, Berg K, Fries BE, et al. Sharing clinical information across care settings: the birth of an integrated assessment system. BMC Health Serv Res. 2009;9:71-81.
Morris J, Berg K, Bjorkgren M, et al. interRAI Clinical Assessment Protocols (CAPS) for Use with Community and Long-term Care Assessment Instruments. interRAI; 2010.
Atkinson J, Salmond C, Crampton P. NZDep2013 Index of Deprivation. Department of Public Health, University of Otago, Wellington; 2014. http://www.otago.ac.nz/wellington/research/hirp/otago020194.html
Shepherd H, Livingston G, Chan J, Sommerlad A. Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC Med. 2019;17(1):130-142.
Gjestsen MT, Bronnick K, Testad I. Characteristics and predictors for hospitalizations of home-dwelling older persons receiving community care: a cohort study from Norway. BMC Geriatr. 2018;18:203-211.
Jian M, Yang G, Fang L, Wan J, Yang Y, Wang Y. Factors associated with healthcare utilization among community-dwelling elderly in Shanghai, China. PLoS One. 2018;13(12):e0207646.
Landi F, Onder G, Cesari M, et al. Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol. 2004;57(8):832-836.
Walter-Ginzburg A, Chetrit A, Medina C, Blumstein T, Gindin J, Modan B. Physician visits, emergency room utilization, and overnight hospitalization in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS). J Am Geriatr Soc. 2001;49(5):549-556.
Dufour I, Chouinard MC, Dubuc N, Beaudin J, Lafontaine S, Hudon C. Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review. BMC Geriatr. 2019;19:185-194.
Jamieson H, Abey-Nesbit R, Bergler U, et al. Evaluating the influence of social factors on aged residential care admission in a national home care assessment database of older adults. J Am Med Dir Assoc. 2019;20(11):1419-1424.
Holdaway M, Wiles J, Kerse N, et al. Predictive factors for entry to long-term residential care in octogenarian Māori and non-Māori in New Zealand, LiLACS NZ cohort. BMC Public Health. 2021;21(1):1-1.
Schluter PJ, Ward C, Arnold EP, Scrase R, Jamieson HA. Urinary incontinence, but not fecal incontinence, is a risk factor for admission to aged residential care of older persons in New Zealand. Neurourol Urodyn. 2017;36(6):1588-1595.
Garner R, Tanuseputro P, Manuel DG. Transitions to long-term and residential care among older Canadians. Health Rep. 2018;29(5):13-23.
Hajek A, Brettschneider C, Lange C, et al. Longitudinal predictors of institutionalization in older age. PLoS One. 2015;10:e0144203.
Diem SJ, Lui LY, Langsetmo L, et al. Effects of mobility and cognition on maintenance of independence and survival among women in late life. J Gerontol A Biol Sci Med Sci. 2018;73(9):1251-1257.
Aspell N, O'Sullivan M, O'Shea E, et al. Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland. Int J Geriatr Psychiatry. 2019;34:999-1007.
Wuorela M, Lavonius S, Salminen M, Vahlberg T, Viitanen M, Viikari L. Self-rated health and objective health status as predictors of all-cause mortality among older people: a prospective study with a 5-, 10-, and 27-year follow-up. BMC Geriatr. 2020;20:120-126.
Nunes BP, Flores TR, Mielke GI, Thume E, Faccini LA. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2016;67:130-138.
Connolly MJ, Hikaka H, Bloomfield K, et al. Research in the retirement village community - the problems of recruiting a representative sample of residents in Auckland, New Zealand. Australas J Ageing. 2021;40:177-183. doi:10.1111/ajag.12898
Concato J, Peduzzi P, Holford TR, Feinstein AR. Importance of events per independent variable in proportional hazards analysis. I. Background, goals, and general strategy. J Clin Epidemiol. 1995;48(12):1495-1501.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373-1379. doi:10.1016/s0895-4356(96)00236-3
Wei LJ, Lin DY, Weissfeld L. Regression analysis of multivariate incomplete failure time data by modeling marginal distributions. J Am Stat Assoc. 1989;84(408):1065-1073.
Gharibvand L, Liu L. Analysis of survival data with clustered events, SAS Global Forum 2009, Washington, DC. http://support.sas.com/resources/papers/proceedings09/237-2009.pdf.Forum2009; 237:1-11.
Sager MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med. 1996;156:645-652.
Close JCT, Lord SR, Antonova EJ, et al. Older people presenting to the emergency department after a fall: a population with substantial recurrent healthcare use. Emerg Med J. 2012;29:742-747.
Gaines JM, Poey JL, Marx KA, Parrish JM, Resnick M. Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples. J Gerontol Soc Work. 2011;54(8):788-802.
Ruchlin HS, Morris S, Morris JN. Resident medical care utilization patterns in continuing care retirement communities. Health Care Financ Rev. 1993;14(4):151-168.
Bynum JP, Andrews A, Sharp S, McCollough D, Wennberg J. Fewer hospitalizations result when primary care is highly integrated into a continuing care retirement community. Health Aff (Millwood). 2011;30(5):975-984.
Marriott L, Dalice S. Indicators of Inequality for Māori and Pacifica people. Wellington, New Zealand: Victoria University, 2014. Working paper 09/2014. https://www.health.govt.nz/publication/wai-2575-maori-health-trends-report
Cohen MZ, Tell EJ, Wallack SS. The risk factors of nursing home entry among residents of six continuing care retirement communities. J Gerontol. 1988 Jan;43(1):S15-S21.
Maxwell CJ, Soo Z, Hogan DB, et al. Predictors of nursing home placement form assisted living settings in Canada. Can J Aging. 2013;32(4):333-348.
Mant A, King M, Saunders NA, Pond CD, Goode E, Hewitt H. Four year follow up of mortality and sleep-related respiratory disturbance in non-demented seniors. Sleep. 1995;18(6):433-438.
Sachs GA, Carter R, Holtz LR, et al. Cognitive impairment predictor of excess mortality: a cohort study. Ann Intern Med. 2011;155:300-308.
Publically funded hospital discharges - 1 July 2016-30 June 2017. NZ Ministry of Health Publications. https://www.health.govt.nz/publication/publicly-funded-hospital-discharges-1-july-2016-30-june-2017