Predicting outcomes of community-based continuing care. Four-year prospective study of functional assessment versus clinical judgment.

OBJECTIVE

To compare the predictive power of functional assessment for death and institutionalization with the clinical judgment of continuing care nurses; to determine the rates of functional impairment in elderly community-based continuing care clients; to describe long-term group trends in this population.

DESIGN

A prospective cohort study, which lasted 4 years.

SETTING

Community-based continuing care nursing program.

PARTICIPANTS

Two hundred thirty-seven elderly (65 years or older) clients of the program.

MAIN OUTCOME MEASURES

Activities of daily living (ADL), cognitive function, and affective function were assessed when clients entered the program (using the Barthel Index, the Canadian Mental Status Questionnaire, and the Memorial University Scale of Happiness). Home care nurses were asked to predict whether individual clients would have died or dropped out of the program at 1 year after entry.

RESULTS

Cognitive function and ADL function tests were significant predictors of both death and drop-out from the program; they were better than clinical judgment. Rates of cognitive and ADL functioning were as expected; the rate of affective impairment (53.6%) was much higher than anticipated. At the end of 4 years, only 22.5% of the cohort were still receiving continuing care.

CONCLUSIONS

Functional assessment of cognitive and ADL domains was a better predictor of outcomes than clinical judgment. Studying the cohort enabled us to describe group trends, which could be valuable for program managers.