Health-Related Problems and Changes After 1 Year as Assessed With the Geriatric ICF Core Set (GeriatrICS) in Community-Living Older Adults Who Are Frail Receiving Person-Centered and Integrated Care From Embrace

Published:April 12, 2019DOI:https://doi.org/10.1016/j.apmr.2019.02.014

      Abstract

      Objective

      To assess the prevalence, severity, and change in health-related problems in a sample of older adults who received individual care and support from Embrace, for the whole sample, per subgroup based on complexity of care needs and frailty, and for those who had at baseline a health-related problem.

      Design

      A pretest-posttest study with assessments at baseline and after 12 months.

      Setting

      Community.

      Participants

      Older adults aged 75 years and older (N=136) who are frail (n=56) or who have complex care needs (n=80).

      Intervention

      Participants received care and support by Embrace, a person-centered and integrated care service for community-living older adults supporting them to age in place. A multidisciplinary team provided care and support, with intensity depending on the older adults' risk profile.

      Main Outcome Measure

      Health-related problems as perceived by older adults and measured with the Geriatric International Classification of Functioning, Disability and Health Core Set.

      Results

      Health-related problems were related to 6 coherent clusters: (1) Mental Functions; (2) Physical Health; (3) Mobility; (4) Personal Care; (5) Nutrition; and (6) Support. The most prevalent and most severe problems at baseline were related to Mental Functions and Mobility. Changes in the prevalence of problems after 12 months varied. Severity scores decreased or remained stable, except for Mobility items which showed a varying changing pattern in participants with complex care needs. Prevalence and severity of problems for those with a problem at baseline decreased after 12 months. Frail participants with a problem had higher baseline severity scores than those with complex care needs experiencing a problem, but differences in changes between individuals who are frail and those with complex care needs were small.

      Conclusions

      The results are encouraging and may indicate that individual, person-centered and integrated care and support from Embrace offers a route to counteracting the decline in physical, cognitive and social functioning associated with aging.

      Keywords

      List of abbreviations:

      GeriatrICS ( Geriatric International Classification of Functioning, Disability and Health Core Set ), GFI ( Groningen Frailty Indicator), ICF ( International Classification of Functioning, Disability and Health), Intermed-E-SA ( Intermed for the Elderly Self-Assessment)
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      References

        • Fabbri E.
        • Zoli M.
        • Gonzalez-Freire M.
        • Salive M.E.
        • Studenski S.A.
        • Ferrucci L.
        Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research.
        J Am Med Dir Assoc. 2015; 16: 640-647
        • Salive M.E.
        Multimorbidity in older adults.
        Epidemiol Rev. 2013; 35: 75
        • Marengoni A.
        • Angleman S.
        • Melis R.
        • et al.
        Aging with multimorbidity: a systematic review of the literature.
        Ageing Res Rev. 2011; 10: 430-439
        • Forouzanfar M.H.
        • Alexander L.
        • et al.
        • GBD 2013 Risk Factors Collaborators
        Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study 2013.
        Lancet. 2015; 386: 2287-2323
        • Chen K.M.
        • Hung H.M.
        • Lin H.S.
        • Haung H.T.
        • Yang Y.M.
        Development of the model of health for older adults.
        J Adv Nurs. 2011; 67: 2015-2025
        • Spoorenberg S.L.
        • Wynia K.
        • Fokkens A.S.
        • Slotman K.
        • Kremer H.P.
        • Reijneveld S.A.
        Experiences of community-living older adults receiving integrated care based on the chronic care model: a qualitative study.
        PLoS One. 2015; 10: e0137803
        • Hardy S.E.
        • Dubin J.A.
        • Holford T.R.
        • Gill T.M.
        Transitions between states of disability and independence among older persons.
        Am J Epidemiol. 2005; 161: 575-584
        • Beard J.R.
        • Bloom D.E.
        Towards a comprehensive public health response to population ageing.
        Lancet. 2015; 385: 658-661
        • World Health Organization
        World report on ageing and health.
        World Health Organization, Geneva, Switzerland2015
        • Boyd C.
        • Fortin M.
        Future of multimorbidity research: how should understanding of multimorbidity inform health system design?.
        Public Health Rev. 2010; 32: 451-474
        • Banerjee S.
        Multimorbidity--older adults need health care that can count past one.
        Lancet. 2015; 385: 587-589
        • Lehnert T.
        • Heider D.
        • Leicht H.
        • et al.
        Review: health care utilization and costs of elderly persons with multiple chronic conditions.
        Med Care Res Rev. 2011; 68: 387-420
        • Nolte E.
        • McKee M.
        Caring for people with chronic conditions - a health system perspective.
        Open University Press, Berkshire, England2008
        • OECD iLibrary
        Health reform: meeting the challenge of ageing and multiple morbidities.
        (Available at:) (Accessed March 15, 2018)
        • World Health Organization
        WHO global strategy on people-centred and integrated health services.
        World Health Organization, Geneva, Switzerland2015
        • European Commission
        State of health in the EU.
        (Available at:) (Accessed March 15, 2018)
        • Bayliss E.A.
        • Edwards A.E.
        • Steiner J.F.
        • Main D.S.
        Processes of care desired by elderly patients with multimorbidities.
        Fam Pract. 2008; 25: 287-293
        • Spoorenberg S.L.
        • Uittenbroek R.J.
        • Middel B.
        • Kremer B.P.
        • Reijneveld S.A.
        • Wynia K.
        Embrace, a model for integrated elderly care: study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care.
        BMC Geriatr. 2013; 13: 62
        • Coleman K.
        • Austin B.T.
        • Brach C.
        • Wagner E.H.
        Evidence on the chronic care model in the new millennium.
        Health Aff (Millwood). 2009; 28: 75-85
        • Wagner E.H.
        • Austin B.T.
        • Davis C.
        • Hindmarsh M.
        • Schaefer J.
        • Bonomi A.
        Improving chronic illness care: translating evidence into action.
        Health Aff (Millwood). 2001; 20: 64-78
        • Singh D.
        • Ham C.
        Improving care for people with long-term conditions: a review of UK and international frameworks.
        NHS Institute for Innovation and Improvement, Birmingham, UK2006
        • Spoorenberg S.L.
        • Wynia K.
        • Uittenbroek R.J.
        • Kremer H.P.
        • Reijneveld S.A.
        Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: a randomised controlled trial on embrace.
        PLoS One. 2018; 13: e0190751
        • Uittenbroek R.J.
        • Kremer H.P.H.
        • Spoorenberg S.L.
        • Reijneveld S.A.
        • Wynia K.
        Integrated care for older adults improves perceived quality of care: results of a randomized controlled trial of embrace.
        J Gen Intern Med. 2017; 32: 516-523
        • Lowsky D.J.
        • Olshansky S.J.
        • Bhattacharya J.
        • Goldman D.P.
        Heterogeneity in healthy aging.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 640-649
        • Topinkova E.
        Aging, disability and frailty.
        Ann Nutr Metab. 2008; 52: 6-11
        • Spoorenberg S.L.
        • Reijneveld S.A.
        • Middel B.
        • Uittenbroek R.J.
        • Kremer H.P.
        • Wynia K.
        The geriatric ICF core set reflecting health-related problems in community-living older adults aged 75 years and older without dementia: development and validation.
        Disabil Rehabil. 2015; 37: 2337-2343
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        PLoS Med. 2007; 4: e296
        • Peters L.
        • Boter H.
        • Slaets J.
        • Buskens E.
        Development and measurement properties of the self assessment version of the INTERMED for the elderly to assess case complexity.
        J Psychosom Res. 2013; 74: 518-522
        • Peters L.L.
        • Boter H.
        • Buskens E.
        • Slaets J.P.
        Measurement properties of the Groningen Frailty Indicator in home-dwelling and institutionalized elderly people.
        J Am Med Dir Assoc. 2012; 13: 546-551
        • Steverink N.
        • Slaets J.P.
        • Schuurmans H.
        • van Lis M.
        Measuring frailty: development and testing of the Groningen Frailty Indicator (GFI).
        Gerontologist. 2001; 41: 236-237
        • Schols J.M.
        • Crebolder H.F.
        • van Weel C.
        Nursing home and nursing home physician: the Dutch experience.
        J Am Med Dir Assoc. 2004; 5: 207-212
        • Anton S.D.
        • Woods A.J.
        • Ashizawa T.
        • et al.
        Successful aging: advancing the science of physical independence in older adults.
        Ageing Res Rev. 2015; 24: 304-327
        • Milte R.
        • Crotty M.
        Musculoskeletal health, frailty and functional decline.
        Best Pract Res Clin Rheumatol. 2014; 28: 395-410
        • de Vries N.M.
        • van Ravensberg C.D.
        • Hobbelen J.S.
        • Olde Rikkert M.G.
        • Staal J.B.
        • Nijhuis-van der Sanden M.W.
        Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis.
        Ageing Res Rev. 2012; 11: 136-149
        • Tovel H.
        • Carmel S.
        Maintaining successful aging: the role of coping patterns and resources.
        J Happiness Stud. 2014; 15: 255-270
        • Thumala Dockendorff D.C.
        Healthy ways of coping with losses related to the aging process.
        Educ Gerontol. 2014; 40: 363-384
        • Pardon M.
        • Bondi M.W.
        Behavioral neurobiology of aging.
        Springer-Verlag, Berlin, Germany2012
        • Harada C.N.
        • Natelson Love M.C.
        • Triebel K.L.
        Normal cognitive aging.
        Clin Geriatr Med. 2013; 29: 737-752
        • Jonker A.A.
        • Comijs H.C.
        • Knipscheer K.C.
        • Deeg D.J.
        The role of coping resources on change in well-being during persistent health decline.
        J Aging Health. 2009; 21: 1063-1082
        • Steverink N.
        • Lindenberg S.
        • Slaets J.
        How to understand and improve older people’s self-management of wellbeing.
        Eur J Ageing. 2005; 2: 235-244
        • Rauch A.
        • Cieza A.
        • Stucki G.
        How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice.
        Eur J Phys Rehabil Med. 2008; 44: 329-342
        • Racca V.
        • Di Rienzo M.
        • Mazzini P.
        • et al.
        ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery.
        Eur J Phys Rehabil Med. 2015; 51: 457-468
        • Yang E.J.
        • Kim B.R.
        • Shin H.I.
        • Lim J.Y.
        Use of the International Classification of Functioning, Disability and Health as a functional assessment tool for breast cancer survivors.
        J Breast Cancer. 2012; 15: 43-50
        • Wynia K.
        • van Wijlen A.T.
        • Middel B.
        • Reijneveld S.A.
        • Meilof J.F.
        Change in disability profile and quality of life in multiple sclerosis patients: a five-year longitudinal study using the Multiple Sclerosis Impact Profile (MSIP).
        Mult Scler. 2012; 18: 654-661
        • Huber E.O.
        • Tobler A.
        • Gloor-Juzi T.
        • Grill E.
        • Gubler-Gut B.
        The ICF as a way to specify goals and to assess the outcome of physiotherapeutic interventions in the acute hospital.
        J Rehabil Med. 2011; 43: 174-177
        • Pisoni C.
        • Giardini A.
        • Majani G.
        • Maini M.
        International Classification of Functioning, Disability and Health (ICF) core sets for osteoarthritis. A useful tool in the follow-up of patients after joint arthroplasty.
        Eur J Phys Rehabil Med. 2008; 44: 377-385
        • Marsden E.
        • Torgerson C.J.
        Single group, pre- and post-test research designs: some methodological concerns.
        Oxford Rev Educ. 2012; 38: 583-616
        • Üstün T.B.
        • Kostanjsek N.
        • Chatterji S.
        • Rehm J.
        Measuring health and disability: manual for WHO disability assessment schedule (WHODAS 2.0).
        World Health Organization, Geneva, Switzerland2010
        • A T.J.
        • Dias A.
        • Philp I.
        • Beard J.
        • Patel V.
        • Prince M.
        Identifying common impairments in frail and dependent older people: validation of the COPE assessment for non-specialised health workers in low resource primary health care settings.
        BMC Geriatr. 2015; 15: 123
        • Olde-Rikkert M.G.
        • Long J.F.
        • Philp I.
        Development and evidence base of a new efficient assessment instrument for international use by nurses in community settings with older people.
        Int J Nurs Stud. 2013; 50: 1180-1183
        • Abellan Van Kan G.
        • Sinclair A.
        • Andrieu S.
        • et al.
        The geriatric minimum data set for clinical trials (GMDS).
        J Nutr Health Aging. 2008; 12: 197-200
        • Stuck A.E.
        • Siu A.L.
        • Wieland G.D.
        • Adams J.
        • Rubenstein L.Z.
        Comprehensive geriatric assessment: a meta-analysis of controlled trials.
        Lancet. 1993; 342: 1032-1036
        • McDonald J.H.
        Handbook of biological statistics.
        3rd ed. Sparky House Publishing, Baltimore2014
        • Dent E.
        • Kowal P.
        • Hoogendijk E.O.
        Frailty measurement in research and clinical practice: a review.
        Eur J Intern Med. 2016; 31: 3-10
        • Kahana E.
        • Kahana B.
        • Lee J.E.
        Proactive approaches to successful aging: one clear path through the forest.
        Gerontology. 2014; 60: 466-474