Tsay Tiffany, Shugrue Noreen, Charles Doreek, Migneault Deborah, McManus Richard, Gruman Cindy, Robison Julie
Virginia Commonwealth University School of Medicine Richmond, VA, USA.
UConn Health Center on Aging Farmington, CT, USA.
J Am Med Dir Assoc. 2022 May;23(5):838-844. doi: 10.1016/j.jamda.2021.07.032. Epub 2021 Aug 20.
With unprecedented demand for Medicaid long-term services and supports, states are seeking to allocate resources in the most efficient way. Understanding the prevalence of frailty and how it varies across home and community-based services (HCBS) populations can assist states with more precise identification of individuals most in need of services. Early identification of individuals more likely to experience frailty changes could allow for enhanced care planning to prevent or slow the progression of decline.
Longitudinal study.
Data from Connecticut's assessment tool (based on interRAI-HC) were analyzed at 2 time points for 16,309 individuals receiving HCBS. The sample included assessments completed between November 1, 2017 and July 15, 2020 across 4 groups: older adults 65+ years old meeting nursing facility level of care (NF LOC), older adults 65+ years old not meeting NF LOC, individuals with acquired brain injury, and individuals <65 years old with physical disability.
We measured frailty using the Frailty Index (FI) and examined change in FI between baseline and follow-up. A change in FI score of at least ±0.03 was classified as a clinically meaningful change. We compared predictors of clinically meaningful decline or improvement using multivariate logistic regression.
In our sample, 54% of individuals experienced a clinically meaningful change: 42% declined and 12% improved. Individuals receiving in-home care services had lower odds of improvement across all HCBS groups and multiple frailty categories with odds ratios ranging from 0.35 to 0.68. Frail older adults 65+ years old meeting nursing facility level of care receiving physical therapy were 21% less likely to experience decline and 1.4 times more likely to improve.
The nature of HCBS support provided can impact changes in frailty status. More reactive services such as in-home care may contribute to frailty decline while rehabilitative services such as physical therapy may protect against decline.
鉴于对医疗补助长期服务与支持的需求空前高涨，各州正寻求以最有效的方式分配资源。了解衰弱的患病率及其在居家和社区服务（HCBS）人群中的差异，有助于各州更精准地识别最需要服务的个体。尽早识别更有可能出现衰弱变化的个体，可加强护理规划，以预防或减缓衰退进程。
纵向研究。
对来自康涅狄格州评估工具（基于interRAI-HC）的数据进行分析，该数据来自16309名接受HCBS服务的个体的两个时间点。样本包括2017年11月1日至2020年7月15日期间完成的评估，涉及4组人群：符合护理机构护理水平（NF LOC）的65岁及以上老年人、不符合NF LOC的65岁及以上老年人、获得性脑损伤个体以及65岁以下身体残疾个体。
我们使用衰弱指数（FI）测量衰弱情况，并检查基线和随访之间FI的变化。FI得分至少±0.03的变化被归类为具有临床意义的变化。我们使用多变量逻辑回归比较具有临床意义的衰退或改善的预测因素。
在我们的样本中，54%的个体经历了具有临床意义的变化：42%衰退，12%改善。在所有HCBS组和多个衰弱类别中，接受居家护理服务的个体改善的几率较低，优势比范围为0.35至0.68。符合护理机构护理水平的65岁及以上衰弱老年人接受物理治疗后，衰退的可能性降低21%，改善的可能性增加1.4倍。
所提供的HCBS支持的性质会影响衰弱状态的变化。诸如居家护理等反应性更强的服务可能会导致衰弱加剧，而诸如物理治疗等康复服务可能有助于防止衰弱。
