scholarly journals First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

2020 ◽  
Author(s):  
Wei-Ju Lee ◽  
Li-Ning Peng ◽  
Chi-Hung Lin ◽  
Shinn-Zong Lin ◽  
Ching-Hui Loh ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Outcome Measures ◽  
Daily Living ◽  
Place Of Death ◽  
Older Person ◽  
Cross Sectional ◽  
Standard Set ◽  
Prospective Longitudinal

Abstract Background: Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset.Methods: The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results: Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease severity (OR 0.40, 95% CI 0.21–0.76, p=0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p=0.014) were less likely to have high value-based healthcare status. Conclusions: The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease and cognitive impairment as important barriers to achieving high value-based healthcare status.

scholarly journals First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

2019 ◽  
Author(s):  
Wei-Ju Lee ◽  
Li-Ning Peng ◽  
Chi-Hung Lin ◽  
Shinn-Zong Lin ◽  
Ching-Hui Loh ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Outcome Measures ◽  
Daily Living ◽  
Place Of Death ◽  
Older Person ◽  
Cross Sectional ◽  
Standard Set ◽  
Prospective Longitudinal

Abstract Background: Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset. Methods: The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions who received value-based healthcare services between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results: Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease severity (OR 0.40, 95% CI 0.21–0.76, p=0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p=0.014) were less likely to have high value-based healthcare status. Conclusions: The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to patient-focused goals. This study identified advanced age, chronic disease and cognitive impairment as important barriers to achieving high value-based healthcare status.

scholarly journals First insights on value-based healthcare of elders using ICHOM older person standard set reporting

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wei-Ju Lee ◽  
Li-Ning Peng ◽  
Chi-Hung Lin ◽  
Shinn-Zong Lin ◽  
Ching-Hui Loh ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Outcome Measures ◽  
Daily Living ◽  
Disease Burden ◽  
Place Of Death ◽  
Older Person ◽  
Standard Set ◽  
Prospective Longitudinal

Abstract Background Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset. Methods The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4%, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease burden (OR 0.40, 95% CI 0.21–0.76, p = 0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p = 0.014) were less likely to have high value-based healthcare status. Conclusions The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease burden and cognitive impairment as important barriers to achieving high value-based healthcare status.

scholarly journals First Insights on Value-Based Healthcare of Elders Using ICHOM Older Person Standard Set Reporting

2020 ◽  
Author(s):  
Wei-Ju Lee ◽  
Li-Ning Peng ◽  
Chi-Hung Lin ◽  
Shinn-Zong Lin ◽  
Ching-Hui Loh ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Outcome Measures ◽  
Daily Living ◽  
Disease Burden ◽  
Place Of Death ◽  
Older Person ◽  
Standard Set ◽  
Prospective Longitudinal

Abstract Background: Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset.Methods: The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. Results: Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease burden (OR 0.40, 95% CI 0.21–0.76, p=0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p=0.014) were less likely to have high value-based healthcare status. Conclusions: The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease burden and cognitive impairment as important barriers to achieving high value-based healthcare status.

scholarly journals Longitudinal Declines in Instrumental Activities of Daily Living in Stable and Progressive Mild Cognitive Impairment

2014 ◽  
Vol 39 (1-2) ◽  
pp. 12-24 ◽  
Author(s):  
Julia J. Hsiao ◽  
Po H. Lu ◽  
Joshua D. Grill ◽  
Edmond Teng
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Disease Progression ◽  
Daily Living ◽  
Cross Sectional ◽  
Functional Deficits ◽  
Functional Activities ◽  
Instrumental Activities ◽  
Cross Sectional Studies

Background: Previous cross-sectional studies suggest that assessments of instrumental activities of daily living (IADLs) may be useful for operationalizing the differences in functional deficits seen in mild cognitive impairment (MCI) and dementia. However, their utility for longitudinal changes in IADLs in the transition between MCI and dementia remains unclear. Methods: We analyzed longitudinal IADL data with the Functional Activities Questionnaire (FAQ) in stable (MCI-S; n = 1,318) or progressive (MCI-P; n = 1,108) MCI patients. Results: Larger increases in FAQ scores were seen in the MCI-P group across a 14.5-month interval, but overlapping distributions in the two groups yielded poorer discriminatory power than prior cross-sectional reports. Conclusion: Our findings emphasize the difficulties in operationalizing the criterion of ‘essentially intact' IADLs in MCI, which may complicate the interpretation of disease progression in MCI treatment trials. © 2014 S. Karger AG, Basel

scholarly journals Factors associated with daily opioid use among aged home care clients: a cross-sectional analysis of Resident Assessment Instrument data

2021 ◽  
Author(s):  
Heidi Mörttinen-Vallius ◽  
Sirpa Hartikainen ◽  
Heini Huhtala ◽  
Lauri Seinelä ◽  
Esa Jämsen
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Home Care ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Assessment Instrument ◽  
Opioid Use ◽  
Cross Sectional ◽  
Resident Assessment ◽  
Resident Assessment Instrument

Abstract Purpose To examine which client characteristics and other factors, including possible adverse effects, identified in the Resident Assessment Instrument—Home Care (RAI-HC) are associated with daily opioid use among aged home care clients. Methods The study sample comprised 2584 home care clients aged ≥ 65 years, of which 282 persons used opioids daily. Clients using opioids less than once daily were excluded. The cross-sectional data were gathered from each client’s first assessment with the RAI-HC during 2014. Multivariable logistic regression was used to study associations of daily opioid use with the clients’ characteristics and symptoms. Results Cognitive impairment was associated with less frequent opioid use after adjusting for pain-related diseases, disabilities and depressive symptoms (OR 0.43, 95% CI 0.32–0.58). The association was not explained by the estimated severity of pain. Osteoporosis, cancer within previous 5 years and greater disabilities in Instrumental Activities of Daily Living (IADL) were associated with daily opioid use regardless of the estimated severity of pain. Depressive symptoms and Parkinson’s disease were associated with daily opioid use only among clients with cognitive impairment, and disabilities in Activities of Daily Living, cancer, arthritis, fractures and pressure ulcers only among clients without cognitive impairment. Constipation was the only adverse effect associated with daily opioid use. Conclusion The pain of home care clients with cognitive impairment may not be treated optimally, whereas there might be prolonged opioid use without a sufficient evaluation of current pain among clients with osteoporosis, cancer within previous 5 years and disabilities in IADLs.

Analysis of Functional and Cognitive Impairment in Institutionalized Individuals with Movement Disorders

2019 ◽  
Vol 19 (7) ◽  
pp. 1022-1031 ◽  
Author(s):  
Paula D. Cebrián ◽  
Omar Cauli
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Cognitive Performance ◽  
Functional Impairment ◽  
Movement Disorders ◽  
Neurological Disorders ◽  
Daily Living ◽  
Severe Cognitive Impairment

Background: Many neurological disorders lead to institutionalization and can be accompanied in their advanced stages by functional impairment, and progressive loss of mobility, and cognitive alterations. Objective: We analyzed the relationship between functional impairment and cognitive performance and its related subdomains in individuals with Parkinson’s disease, Alzheimer’s disease accompanied by motor dysfunction, and with other neurological disorders characterized by both motor and cognitive problems. Methods: All participants lived in nursing homes (Valencia, Spain) and underwent cognitive evaluation with the Mini-Mental State Examination; functional assessment of independence in activities of daily living using the Barthel score and Katz index; and assessment of mobility with the elderly mobility scale. Results: The mean age of the subjects was 82.8 ± 0.6 years, 47% of the sample included individuals with Parkinson’s disease, and 48 % of the sample presented severe cognitive impairment. Direct significant relationships were found between the level of cognitive impairment and functional capacity (p < 0.01) and mobility (p < 0.05). Among the different domains, memory impairment was not associated with altered activities of daily living or mobility. The functional impairment and the risk of severe cognitive impairment were significantly (p<0.05) higher in female compared to male patients. Among comorbidities, overweight/obesity and diabetes were significantly (p < 0.05) associated with poor cognitive performance in those individuals with mild/moderate cognitive impairment. Conclusion: In institutionalized individuals with movement disorders there is an association between functional and cognitive impairment. Reduction of over-weight and proper control of diabetes may represent novel targets for improving cognitive function at such early stages.

scholarly journals Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pi-Hsia Lee ◽  
Ting-Ting Yeh ◽  
Hsin-Yen Yen ◽  
Wan-Ling Hsu ◽  
Valeria Jia-Yi Chiu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Longitudinal Study ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Skill Training ◽  
Community Dwelling ◽  
Combined Effects ◽  
Stroke Group ◽  
The Individual ◽  
Community Dwelling Older Adults

AbstractStroke and cognitive impairment are common in older population. They often occur together and their combined effects significantly increase disability in both basic (BADLs) and instrumental (IADLs) activities of daily living. We investigated the individual and combined impacts of stroke and cognitive impairment on BADLs and IADLs. A total of 3331 community-dwelling older adults were enrolled from the Taiwan longitudinal study on aging in 2011. Both BADLs and IADLs were analyzed. Combination of stroke and cognitive impairment increased severity of ADL disabilities, but similar prevalence, similar numbers of summed BADL and IADL tasks with disability, and similar levels of difficulty for each BADL and IADL task were found between the stroke group and cognitive impairment group. The former had more difficult in dressing while the latter had more difficult in using the telephone, transport, and managing finances. A hierarchy of ADLs was also observed in all groups. ADL skill training supplemented with cognitive and physical interventions should focus on secondary prevention of dementia and improve motor functional capacity to reduce loss of ADLs.

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