Author:
Guthrie Dawn M.,Williams Nicole,O’Rourke Hannah M.,Orange Joseph B.,Phillips Natalie,Pichora-Fuller M. Kathleen,Savundranayagam Marie Y.,Sutradhar Rinku
Abstract
Abstract
Background
To develop and validate a prediction tool, or nomogram, for the risk of a decline in cognitive performance based on the interRAI Cognitive Performance Scale (CPS).
Methods
Retrospective, population-based, cohort study using Canadian Resident Assessment Instrument for Home Care (RAI-HC) data, collected between 2010 and 2018. Eligible home care clients, aged 18+, with at least two assessments were selected randomly for model derivation (75%) and validation (25%). All clients had a CPS score of zero (intact) or one (borderline intact) on intake into the home care program, out of a possible score of six. All individuals had to remain as home care recipients for the six months observation window in order to be included in the analysis. The primary outcome was any degree of worsening (i.e., increase) on the CPS score within six months. Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of a deterioration in the CPS score. Model performance was assessed on the validation cohort using discrimination and calibration plots.
Results
We identified 39,292 eligible home care clients, with a median age of 79.0 years, 62.3% were female, 38.8% were married and 38.6% lived alone. On average, 30.3% experienced a worsening on the CPS score within the six-month window (i.e., a change from 0 or 1 to 2, 3, 4, 5, or 6). The final model had good discrimination (c-statistic of 0.65), with excellent calibration.
Conclusions
The model accurately predicted the risk of deterioration on the CPS score over six months among home care clients. This type of predictive model may provide useful information to support decisions for home care clinicians who use interRAI data internationally.
Funder
Canadian Institutes of Health Research
Publisher
Springer Science and Business Media LLC
Subject
Geriatrics and Gerontology
Reference64 articles.
1. World Health Organization. A blueprint for dementia research. Geneva: World Health Organization; 2022.
2. World Health Organization. Global action plan on the public health response to dementia 2017–2025. Geneva: World Health Organization; 2017.
3. Olivari BS, French ME, McGuire LC. The public health road map to respond to the growing dementia crisis. Innov Aging. 2020;4:1–11.
4. deAlmeida Mello J, Macq J, Van Durme T, Ces S, Spruytte N, Van Audenhove C, et al. The determinants of informal caregivers’ burden in the care of frail older persons: a dynamic and role-related perspective. Aging Ment Health. 2016;21:1–6.
5. Oldenkamp M, Hagedoorn M, Slaets J, Stolk R, Wittek R, Smidt N. Subjective burden among spousal and adult-child informal caregivers of older adults: results from a longitudinal cohort study. BMC Geriatr. 2016;16:208.