Minimum Data Set-Home Care Research Articles

Associations between hypertension and cognitive, mood, and behavioral parameters in very old adults: results from the IlSIRENTE study.

Studies on the associations between hypertension-related parameters and cognitive function, mood, and behavioral symptoms in older adults have produced mixed findings. A possible explanation for these divergent results is that investigations have not adequately adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs). Therefore, the present study examined the cross-sectional associations between hypertension-related parameters, ACEI use, and cognitive function, mood, and behavioral symptoms in very old adults. This study was conducted by analyzing the IlSIRENTE database, a prospective cohort study that collected data on all individuals aged 80 years and older residing in the Sirente geographic area (n = 364). Blood pressure (BP) was assessed after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. Cognitive function, mood, and behavioral symptoms were recorded using the Minimum Data Set Home Care instrument. Blood inflammatory markers were measured. Hypertension-related parameters were significantly associated with many cognitive, mood, and behavioral parameters after adjustment for covariates. However, only the inverse association between hypertension and lesser problems with short-term memory remained significant. Participants with hypertension had lower blood concentrations of inflammatory markers in comparison to their normotensive peers. Findings from the present study indicate that high BP values are associated with fewer complaints about memory problems in very old adults. Furthermore, a lower concentration of inflammatory markers was found in hypertensive participants. ACEI use might affect this scenario.

The role of geriatric syndromes in predicting unplanned hospitalizations: a population-based study using Minimum Data Set for Home Care

BackgroundThe predictive accuracies of screening instruments for identifying home-dwelling old people at risk of hospitalization have ranged from poor to moderate, particularly among the oldest persons. This study aimed to identify variables that could improve the accuracy of a Minimum Data Set for Home Care (MDS-HC) based algorithm, the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale, in classifying home care clients’ risk for unplanned hospitalization.MethodsIn this register-based retrospective study, factors associated with hospitalization among home care clients aged ≥ 80 years in the City of Tampere, Finland, were analyzed by linking MDS-HC assessments with hospital discharge records. MDS-HC determinants associated with hospitalization within 180 days after the assessment were analyzed for clients at low (DIVERT 1), moderate (DIVERT 2–3) and high (DIVERT 4–6) risk of hospitalization. Then, two new variables were selected to supplement the DIVERT algorithm. Finally, area under curve (AUC) values of the original and modified DIVERT scales were determined using the data of MDS-HC assessments of all home care clients in the City of Tampere to examine if addition of the variables related to the oldest age groups improved the accuracy of DIVERT.ResultsOf home care clients aged ≥ 80 years, 1,291 (65.4%) were hospitalized at least once during the two-year study period. Unplanned hospitalization occurred following 15.9%, 22.8%, and 33.9% MDS-HC assessments with DIVERT group 1, 2–3 and 4–6, respectively. Infectious diseases were the most common diagnosis within each DIVERT groups.Many MDS-HC variables not included in the DIVERT algorithm were associated with hospitalization, including e.g. poor self-rated health and old fracture (other than hip fracture) (p 0.001) in DIVERT 1; impaired cognition and decision-making, urinary incontinence, unstable walking and fear of falling (p < 0.001) in DIVERT 2–3; and urinary incontinence, poor self-rated health (p < 0.001), and decreased social interaction (p 0.001) in DIVERT 4–6. Adding impaired cognition and urinary incontinence to the DIVERT algorithm improved sensitivity but not accuracy (AUC 0.64 (95% CI 0.62–0.65) vs. 0.62 (0.60–0.64) of the original DIVERT). More admissions occurred among the clients with higher scores in the modified than in the original DIVERT scale.ConclusionsCertain geriatric syndromes and diagnosis groups were associated with unplanned hospitalization among home care clients at low or moderate risk level of hospitalization. However, the predictive accuracy of the DIVERT could not be improved. In a complex clinical context of home care clients, more important than existence of a set of risk factors related to an algorithm may be the various individual combinations of risk factors.

Role of frailty in prediction of hospitalized older adult patient’s outcomes: a prospective study

Background/aim Frailty is associated with an increased risk of negative short-term and long-term hospital outcomes. This study aimed to evaluate the role of frailty in predicting readmission, length of stay, and quality of life in the hospitalized older adults.Materials and methods This observational study was conducted at Ziaiyan Hospital, Tehran, Iran. In total, 304 participants (65–85 years), were enrolled through the inclusion criteria from August to December 2019. The frailty index (FI) was assessed by the minimum data set-home care. Readmission was obtained through telephone interviews. The length of stay was gathered by the patient’s hospital records, and the EuroQol questionnaire was used for assessing the quality of life. Data were collected by a researcher nurse at the admission time, 30, 60, and 90 days after discharge. The logistic regression model and repeated measures ANOVA were employed to analyze the association between frailty and outcomes.ResultsAccording to FI, 102 (33.55%) participants were pre-frail, whereas 35 (11.51%) were frail. In the fully-adjusted model for readmission, the pre-frail participants had a higher risk of readmission at the hospital in comparison with the nonfrail and frail groups (OR = 1.88, 95% CI = 1.90–3.26), and also for GP visits, frail patients showed nearly significant differences (OR = 2.45, 95% CI = 0.99–6.06) but there were no differences between frail and pre-frail patients in readmissions in the emergency ward. In a fully-adjusted prolonged stay model, pre-frail patients had a higher probability to stay longer in hospital (OR = 2.28, 95% CI: 1.24–4.18). The fully-adjusted model for QoL showed, frail patients were more prone to the declined levels of QoL in comparison with pre-frail patients (OR = 10.77, 95% CI: 3.97–29.18).ConclusionsThe findings indicated that frailty worsened negative outcomes and declined QoL. Early diagnosis in hospital settings could be beneficial for designing optimal care plans for the frail and pre-frail patients.

Diagnosis of frailty in geriatric patients: Is the pictorial fit frail scale an appropriate screening tool in hospital settings?

Background:Frailty is accompanied by serious health complications in the elderly, especially during hospitalization. Visual scales have been designed for quick and easy evaluation of frailty in different cultures and settings. Therefore, this study aimed to define the accuracy of the Pictorial Fit Frail Scale (PFFS) for frailty screening in the hospitalized elderly in Iran.Methods:This cross-sectional study was conducted on 304 hospitalized participants, aged 65-85 years old admitted at Ziaeian Hospital (Tehran) were enrolled through the inclusion criteria from August to December 2019. All participants were evaluated based on the Minimum Data Set-Home Care, the Pictorial Fit Frail Scale, and the Quality-of-Life instrument, through face-to-face interviews by a trained nurse at the admission time. Spearman’s correlation coefficient, and ROC analysis were performed using SPSS at p<0.05.Results:The highest correlation was obtained by Frailty Index (FI) and PFFS (0.770). FI had a negative correlation with QoL (-0.48). The optimal cut-points for PFFS according to FI ≤ 0.08 (robust vs. pre-frail) was obtained 0.10 with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00% and the best cut-point for PFFS based on FI ≥ 0.25 (pre-frail vs. frail) was obtained 0.29 with sensitivity and specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00%.Conclusion:It seems the Pictorial Fit-Frail Scale (PFFS) is a reliable scale with a high level of accuracy, and excellent sensitivity and specificity to measure the frailty level in hospitalized elderlies.

Investigating Risk Factors for Falls among Community-Dwelling Older Adults According to WHO's Risk Factor Model for Falls.

The World Health Organization developed the Risk Factor Model for Falls to describe fall risks in a comprehensive manner. However, there was a lack of study adopting such framework in quantifying falls risk from different factors in a single model. Therefore, this study examined the risk factors from four domains in the Risk Factor Model for Falls among older adults. Secondary data analysis of 10-year assessment records of the Minimum Data Set-Home Care instrument. Hong Kong. 89,100 community-dwelling adults aged 65 and over who first applied for publicly funded long-term care services from 2005 to 2014. The Minimum Data Set-Home Care instrument was used to ascertain older adults' care needs and match them with appropriate services. Additionally, meteorological records from the same period were extracted from the Hong Kong Observatory. The logistic regression model was used to examine risk factors and their associations with falls. In total 70 factors were included in the analysis, of which 37 were significantly associated with falls. Behavioral risk factors generally had greater odds ratios of falling, as compared with biological, socioeconomic, and environmental factors. Out of all significant factors, functional status, alcohol drinking, and locomotion outdoors had the largest odds ratios of falling. Behavioral risk factors for falls are of remarkable influence yet are modifiable among older adults. Hence, falls prevention programs may need to prioritize addressing these factors.

The Relationship with Previous Use of Community-Based Services and Informal Caregiver Support and Elderly and Informal Caregivers’ Views of Living Arrangement: Analysis of Official Statistics from 2004 to 2014

Background and Objectives: Views on living arrangement from elderly and informal caregivers are crucial to “ageing in place”. They might be related to the experience in the use of elderly care services, which remains inconclusive in previous literature. This study aimed to explore the association of previous experience in formal and informal long-term care services with views of both elderly and their informal caregivers on living arrangement. Research Design and Methods: This study adopted a cross-sectional design. Assessment records of Minimum Data Set-Home Care for community-dwelling elderly who were eligible for subsidized long-term care services in Hong Kong from 2004 to 2014 were made available. Multivariate logistic regression was applied to examine associations between both views on elder’s living arrangement from the elderly, caregivers and their previous informal caregiver support, and experience in formal care services. Results: 82,306 dyads of elderly and informal caregivers were included in the analysis. The elderly with previous use of home and community-based services (OR = 0.84, 95% CI 0.80 - 0.88) and informal caregivers (OR = 0.78, 95% CI 0.76 - 0.81) believed that the elderly should live away from home. Temporal trends of fewer elderly and caregivers supporting the idea of living away from home were also observed. Discussion and Implications: The results highlighted the importance of informal caregiver’s support and previous utilization of formal home and community-based services. It was concluded that resources and information of community-based care have a significant association with views on living at home also proper support services and training of care for the elderly should be made available to informal caregivers to reduce their burden.

Improving primary level home and community care services for older people: The case of Hong Kong

The aims of this study were to assess the impairment levels of users and waitlisted applicants for Hong Kong's Integrated Home Care Services (Ordinary Cases) (IHCS [OC]), reveal their possible hidden needs and potential demand for higher level services, assess their unmet needs for IHCS (OC) and explore whether not using IHCS (OC) was associated with any deterioration in impairment. In all, 567 respondents were clinically assessed twice, over a 6‐month interval, by the Minimal Data Set Home Care questionnaire. The results showed that some moderately or severely impaired respondents had only limited access to higher level services. Some respondents with either no impairment or only low‐level impairment had applied for higher level services. Most waitlisted applicants had not received any IHCS (OC), even after 6 months of waiting. Using IHCS (OC) or not had no significant impact on the deterioration in impairment. Several ways of improving home and community care services are discussed.

Can domestic helpers moderate distress of offspring caregivers of cognitively impaired older adults?

ABSTRACTObjective: This study examined the moderating effect of domestic helpers on distress of offspring caring for parents with cognitive impairments and with or without behavioural problems.Method: This secondary analysis of data involved 5086 Hong Kong Chinese adults aged 60 or older applying for public long-term care services from 2010 to 2012. All variables were measured using the mandatory Hong Kong version of the Minimum Data Set-Home Care 2.0.Results: Regarding taking care of parents with cognitive impairments, 10.7% of offspring primary caregivers were aided by domestic helpers, 55.54% reported distress, and 75.70% lived with their parents. Assistance from domestic helpers reduced offspring caregiver distress if the offspring provided psychological support to parents (ratio of OR = 0.655, p < .05) and were not living with parents (ratio of OR = 1.183, p < .01).Conclusion: These findings might suggest: a) the positive effects of audience on psychological responses to stress; b) caregiving is usually less stressful for informal caregivers not residing with care recipients. Conversely, having a domestic helper could add to caregiving distress if offspring caregivers live with their parents, most likely because offspring may witness difficulties that domestic helpers face in providing dementia care.

Prevalence and correlates of abuse screening items among community‐dwelling Hong Kong Chinese older adults

The present study aims to describe the prevalence of potential elder abuse, and to examine correlates of abuse screening items among Chinese community-dwelling older adults. We analyzed the data of 3435 older persons aged ≥60 years who had first applied for the long-term care services in Hong Kong and completed the screening tool (Minimum Data Set-Home Care) in 2006. For each of the five abuse screening items ("fearful of a family member/caregiver," "unexplained injuries/broken bones/burns," "physically restrained," "unusually poor hygiene" and "neglected/abused/mistreated"), we examined its relationship with four types of factors: older person, perpetrator, relationship and environment. The rates of individual abuse screening items ranged from 3.9% for physically restrained to 0.03% for unexplained injures/broken bones/burns. Physically restrained was positively associated with activities of daily living impairments, instrumental activities of daily living impairments, perceived poor health, physically abusive behavior and caregiver mental health. Unusually poor hygiene was positively associated with socially inappropriate behavior and actively resisted care. "Fearful of a family member/caregiver" was positively associated with perceived poor health, conflicting relationship and mental health, and negatively with care activities. Neglected/abused/mistreated was positively associated with age and informal care, and negatively with care activities. We identified a number of associated factors of different abuse screening items among older adults. Our findings could inform healthcare practitioners in identifying those older persons who might be at higher risk of abuse, and provide a knowledge base on which to develop effective preventive measures in the Chinese population. Geriatr Gerontol Int 2017; 17: 150-160.

시력저하노인의 기능상태, 자기효능감, 삶의 만족에 관한 연구

Purpose: This purpose of study was to investigate the relationships among functional state, self-efficacy, and life satisfaction in the elderly with decreased visual acuity. Methods: The subjects were 162 elderly people from the G university hospital. Functional state was measured by Late-Life Function and Disability Instrument (LLFDI) and Minimum Data Set-Home Care version 2.0 (MDS HC 2.0). Self-efficacy and Life satisfaction were measured by the tool of Rho & Lee (2011) and Yoon (2007). Data were analyzed using t-test, ANOVA, Pearson's Correlation Coefficient, and logistic regression. Results: The daily life function was significantly associated with self-efficacy and vision decrease. The regression model with these two variables explained 35.6% of the variance of daily life function. IADL was significantly associated with vision decrease, age, gender, and self-efficacy. The regression model with the three variables explained 52.9% of the variance of IADL. Life satisfaction is significantly associated with self-efficacy, daily life function, vision decrease and IADL. The last regression model with the four variables explained 51.8% of the variance of life satisfaction. Conclusion: The levels of functional state, self-efficacy and life satisfaction in the elderly with decreased visual acuity were low. Self-efficacy was an important factor that influences on the functional state and life satisfaction. Therefore, nursing interventions that can enhance the self-efficacy are required in order to increase the functional state and life satisfaction in the elderly with decreased visual acuity.

Associations Between Secondary Caregivers’ Supportive Behavior and Psychological Distress of Primary Spousal Caregivers of Cognitively Intact and Impaired Elders

This study examined associations between the availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. A sample of 8,087 assessments using the validated Chinese version of the Minimum Data Set-Home Care of individuals applying for government-subsidized long-term care services from 2006 to 2009 in Hong Kong were selected based on inclusion criteria. More than 70% of primary caregivers had secondary caregivers; the rate was slightly lower for those caring for moderately or severely cognitively impaired spouses. More than half of the primary spousal caregivers had secondary caregivers who provided both emotional and instrumental support. Emotional support provided by secondary caregivers had a negative association with primary caregivers' psychological distress when their care recipients were cognitively intact. When secondary caregivers provided both instrumental and emotional support, primary caregivers had a higher likelihood of psychological distress when care recipients had greater negative mood symptoms as compared to those who had less negative mood symptoms. This is the first study that examined the association between availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. The findings suggest a need to provide services that enhance the provision of emotional support from both secondary and primary caregivers to cognitively intact elders and support primary spousal caregivers to seek appropriate help according to the mood of care recipients.

Do Older Adults With Cancer Fall More Often? A Comparative Analysis of Falls in Those With and Without Cancer

To examine whether a history of cancer increased the likelihood of a fall in community-dwelling older adults, and if cancer type, stage, or time since diagnosis increased falls. A longitudinal, retrospective, cohort study. A home- and community-based waiver program in Michigan. 862 older adults aged 65 years or older with cancer compared to 8,617 older adults without cancer using data from the Minimum Data Set-Home Care and Michigan cancer registry. Reports of falls were examined for 90-180 days. Generalized estimating equations were used to compare differences between the groups. Cancer, falls, patient characteristics, comorbidities, medications, pain, weight loss, vision, memory recall, and activities, as well as cancer type, stage, and time since diagnosis. A fall occurred at a rate of 33% in older adults with cancer compared to 29% without cancer (p < 0.00). Those with a history of cancer were more likely to fall than those without cancer (adjusted odds ratio 1.16; 95% confidence interval [1.02, 1.33]; p = 0.03). No differences in fall rates were determined by cancer type or stage, and the odds of a fall did not increase when adding time since cancer diagnosis. The fall rate was higher in older adults with cancer than in older adults without cancer. Nurses need to assess fall risk and initiate fall prevention measures for older adults at the time of cancer diagnosis. When caring for older adults with cancer, nurses should be aware of an increased risk for falls. Healthcare staff also should be aware of an increased risk for falls in that population during cancer treatment. Evidence-based fall prevention measures should be included in care plans for older adult cancer survivors.

Associations Among Indicators of Depression in Medicaid-Eligible Community-Dwelling Older Adults

The purpose of this research was to examine associations among 2 separate Minimum Data Set-Home Care (MDS-HC) depression measures (the Depression Rating Scale [DRS] and medical diagnosis of depression) with billed antidepressant medications in Medicaid paid claim files. The sample for this cross-sectional research included 3,041 Medicaid-eligible older adult participants in a Home and Community Based Waiver Program and used data from the MDS-HC, Version 1 and Medicaid Paid Claim Files. Sensitivity and specificity analyses, receiver operating characteristic (ROC) curve analysis, and t tests were utilized. DRS scoring indicated that 15.4% of participants had behaviors indicative of depression, whereas 42% had a medical diagnosis of depression noted in the MDS-HC. Of those with a medical diagnosis of depression, 51% had a prescribed antidepressant medication. ROC analysis suggested that the DRS was a poor distinguisher of participants with and without a medical diagnosis of depression or prescribed antidepressant medications. Approximately half of Medicaid-eligible older adults medically diagnosed with depression were treated pharmacologically. Longitudinal research is recommended to assess responsiveness of the DRS over time to pharmacological and psychotherapeutic interventions for depression.

Breast and Colorectal Cancer Screening and Associated Correlates among Chinese Older Women

To explore the participation rates for breast and colorectal cancer screening and identify associated correlates among elderly women. Logistic regressions were conducted using data collected in 2006 from 1,533 elderly women aged 60 years or above who had completed a screening instrument, the Minimum Data Set-Home Care, while applying for long-term care services at the first time in Hong Kong. The participation rates for breast and colorectal cancer screening among frail older Chinese women were 3.7% and 10.8% respectively. Cognitive status was inversely associated with the likelihood of participation in screening (breast: OR = 0.66, 95%CI = 0.47-0.94; colon: OR = 0.81, 95%CI = 0.66-0.99), as was educational level with the likelihood of participation in breast cancer screening (no formal education: OR = 0.20, 95%CI = 0.06-0.61, some primary education: OR = 0.31, 95%CI = 0.10-1.00). The delivery of cancer preventive health services to frail older women is less than ideal. Cognitive status and educational level were important factors in cancer screening behaviour. Tailor-made strategic promotion programmes targeting older women with low cognitive status and educational levels are needed to enhance awareness and acceptance within this vulnerable group.

Minimal Data Set-Home Care Has an Added Value in the Admission Procedure for a Nursing Home

Objectives: To investigate how the request for nursing home admission is performed and whether Minimum Data Set (MDS) Home Care can contribute to the process of admission to a nursing home. Methods: Design: Observational study. Participants: Persons on a priority waiting list for a public nursing home (n=47). Measurements: Inventory of the added information provided by the use of the MDS Home Care and an inventory by the general practitioner. Results: People on the waiting list scored well for activities of daily living but live in a vulnerable home-care situation, caused by severe communication problems or/and pain or/and a higher level of cognitive problems than expected on regular data. Conclusion: The admission procedure to nursing homes has to be adapted. The MDS Home Care can be an additional tool.

The Contribution Falls Have to Increasing Risk of Nursing Home Placement in Community-Dwelling Older Adults

To determine whether a fall, as an adverse event in combination with other risk factors, influences nursing home placement (NHP). A retrospective longitudinal study of 6,515 high-risk, community-dwelling, dually eligible (Medicare/Medicaid) participants in a waiver program during 2002-2007 are examined. Data are obtained from the Minimum Data Set-Home Care linked with Medicaid claim files. The authors fit multiple factors to a logistic curve, using generalized linear modeling to predict increased risk of NHP when a fall occurred. Prior NHP and an increased rate of falls (Odds Ratio [OR] = 1.52, 95% Confidence Interval [CI] = 1.25-1.84) and prior NHP and the same rate of falls (OR = 1.55, 95% CI = 1.26-1.91) both increased NHP. An adverse event such as a fall and prior NHP is a strong predictor of future NHP and should be taken into consideration while developing care plans for community-dwelling older adults.

A psychometric evaluation of a negative mood scale in the MDS-HC using a large sample of community-dwelling Hong Kong Chinese older adults

negative mood is an important construct when assessing the health of older persons. The profile of mood states questionnaire is commonly used to measure mood; however, it might not be suitable for older adults with low education level and those who are not originated North American. to examine a negative mood scale formed by nine items in the Mood Section of the Minimum Data Set-Home Care of the Resident Assessment Instrument. a secondary analysis of data from 3,523 older persons aged 60 or over who had first applied for the long-term care services in Hong Kong and completed the screening tool in 2006. Exploratory and confirmatory factor analyses were used to test the factor structure and multiple-group confirmatory factor analysis to test the gender invariance of the Negative Mood Scale in the Minimum Data Set-Home Care. Its reliability using Cronbach's alpha was examined. both a three-factor model at the first level and a one-factor model at the second level provided excellent fits to the overall data, and held equally well for both males and females, and two randomly split samples. Multiple-group confirmatory factor analyses revealed both genders demonstrating an equivalent pattern of factor loadings. Cronbach's alpha value was acceptable for the overall data (0.66). the Negative Mood Scale is a reliable and valid scale and both genders responded to it using the same framework and metric, suggesting it could be used to measure negative mood in Chinese community-dwelling older adults. Further testing of the instrument is needed.

An Evaluation of the Factor Structure of the Instrumental Activities of Daily Living Involvement and Capacity Scales of the Minimum Data Set for Home Care for Elderly Chinese Community Dwellers in Hong Kong

The objective of this study was to evaluate the factor structure of the Instrumental Activities of Daily Living (IADL) Involvement and Capacity scales of the Chinese version of the Minimum Data Set–Home Care (MDS-HC) in a sample of Chinese older adults living in Hong Kong (n = 3,523). The results of confirmatory factor analyses supported the one-factor model for both IADL Involvement and IADL Capacity scales. Evidence indicated that both scales had good internal consistency (.88) and were reliable and valid in assessing IADL among elderly Chinese community dwellers.

Social functioning, polypharmacy and depression in older Chinese primary care patients

Objective: This study aims to identify the relationship among social functioning, polypharmacy and depression among older patients in Hong Kong. Method: Three out of 18 elderly health centres were selected using the cluster sampling method. 457 elders were randomly selected from all the patients aged 65 and over attending the centres, and were interviewed using the Chinese Minimum Data Set-Home Care in 1999. Of them 318 were re-assessed in 2000. Results: At follow-up, their mean age was 73.6 (SD = 5.5), of whom 51.6% were females. Besides negative emotions, respondents’ increased depressive symptoms were associated with using more than four medications and decline in social functioning over time, and behavioural agitation at baseline. If there was no medication review at baseline, the impact of polypharmacy on depression was subsided. Conclusion: Medication review is important in the prediction and treatment process of depression as it can moderate the impact of social functioning and polypharmacy. Therefore, medical professionals should prescribe fewer medications to eliminate adverse drug reactions and reduce depressive symptoms. However, the study reflects that older adults might feel depressed by not being able to control the result of their reviews. Thus, if the review could involve older patients, it might be more assuring and helps to restore their hope for gaining control in their treatment process.

Effects of anorexia on mortality among older adults receiving home care: an observation study.

We describe the prevalence of secondary anorexia in a population of older people living in community and receiving home care. In addition, we examined the relationship between secondary anorexia and mortality. We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs. A total of twelve Home Health Agencies participated in such project evaluating the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 2757 patients were enrolled in the present study. The main outcome measures were the prevalence of anorexia, weight loss and survival. More than 25% (744 subjects) of the study sample suffered from anorexia. During a mean follow-up of 10 months from initial MDS-HC assessment, 468 patients (17%) died. There was uneven distribution of the risk. After adjusting for age, gender and for all other possible risk factors for death (living alone, physical and cognitive disability, behavior problems, urinary incontinence, pressure ulcer, hearing impairment, congestive heart failure, hypertension, depression, diabetes, renal failure, cancer), subjects with anorexia were more likely to die relative to patients without anorexia (RR, 1.83; 95% CI 1.45-2.31). Even though the risk of mortality was higher among subjects suffering from anorexia and weight loss, the anorexia per se was associated with higher risk compared with subjects without anorexia (RR, 1.45; 95% CI 1.01-2.19). Anorexia is associated with a significant higher risk of all-cause mortality. The present findings support the possibility that anorexia has an independent effect on survival even among old people receiving home care.