John N Morris1, Katherine Berg2, Elizabeth P Howard3, Palmi V Jonsson4, Meredith Craig5. 1. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA. 2. Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada. 3. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Connell School of Nursing, Boston College, Chestnut Hill, MA. Electronic address: Elizabeth.howard@bc.edu. 4. Department of Geriatrics, Landspitali University Hospital, Reykjavík, Iceland; Department of Geriatrics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 5. Bouve College of Health Sciences, Northeastern University, Boston, MA.
Abstract
OBJECTIVE: To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. DESIGN: Retrospective longitudinal analysis of an international home care database. SETTING AND PARTICIPANTS: 523,907 persons receiving home care, having 2 assessments, on average, 8 months apart. MEASURES: Recovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale. RESULTS: The Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy. CONCLUSIONS/IMPLICATIONS: The Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery.
OBJECTIVE: To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. DESIGN: Retrospective longitudinal analysis of an international home care database. SETTING AND PARTICIPANTS: 523,907 persons receiving home care, having 2 assessments, on average, 8 months apart. MEASURES: Recovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale. RESULTS: The Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy. CONCLUSIONS/IMPLICATIONS: The Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery.
Authors: Caitlin McArthur; Andrew Faller-Saunders; Luke A Turcotte; Chi-Ling Joanna Sinn; Katherine Berg; John N Morris; John P Hirdes Journal: J Am Med Dir Assoc Date: 2022-06-27 Impact factor: 7.802