A quantitative method of identifying older persons at risk for increasing long term care services

Abstract

The purpose of this study was to test the utility of upper and lower extremity performance, grip strength, and mental status as predictors of stability or chronic deterioration in a cohort of frail older persons. The study population consisted of a random sample of forty patients selected from residents of an intermediate level care facility. Demographic information, manual ability, mental status, grip strength, mobility, active and resolved medical problems, medications, and professional's estimate of each participant's likelihood of requiring skilled nursing care were obtained within 2 weeks after identifying the sample. Manual ability, mental status, grip strength, and mobility were included in a Performance Index to predict functional ability. Study participants were followed for 2 years to observe which individuals remained at the intermediate care level and which persons required transfer to skilled nursing care. Of the 27 persons who completed the study, 21 persons remained stable (Group 1) and 6 individuals were transferred to skilled nursing care (Group 2) over the 2 year follow-up period. Group comparisons of the mean values revealed statistically significant differences for age, manual ability and the Performance Index. The Performance Index was a statistically significant predictor of increasing dependency (p < 0.005). Within Group 1, no patients had a performance score which suggested a poor outcome; only one person in Group 2 had a prediction of the favorable outcome. Professional judgement correctly predicted 16 of the 21 persons in Group 1 and 2 of the 6 persons in Group 2. We conclude that at least four dimensions of functional measurement; upper extremity performance, mental status, grip strength and ambulation can be used to make accurate predictions regarding the overall stability of an institutionalized frail older person. The implications of these findings are significant for clinicians, geriatric researchers and health planners. © 1984.

Publication Title

Journal of Chronic Diseases

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