The association between chronic illness and functional change among participants in a comprehensive geriatric assessment program.
OBJECTIVE
To examine the association between chronic illness and functional status change during a 3-year period in older people enrolled in an in-home comprehensive geriatric assessment (CGA) and preventive care program.


METHODS
Secondary analysis of data from a longitudinal cohort study.


METHODS
Santa Monica, California.


METHODS
Two hundred two community-dwelling older persons (mean age at baseline was 81 years, 70% were women, and 72% reported good health) randomized to the intervention group in a trial of in-home comprehensive geriatric assessment and preventive care.


METHODS
We studied 13 common chronic illnesses/conditions determined clinically from an annual comprehensive evaluation by gerontologic nurse practitioners (GNPs) in consultation with study geriatricians. These target conditions included hypertension, osteoarthritis, coronary artery disease, obesity, undernutrition, urinary incontinence, sleep disorders, falls, gait/balance disorders, hearing and vision deficits, depression, and unsafe home environment. The dependent variable was functional change as measured by instrumental activities of daily living (IADL) and basic activities of daily living (BADL) assessed at baseline and annually for 3 years by independent research personnel. Potential confounding variables, including comorbid conditions and other subject characteristics, were controlled for in the analyses.


RESULTS
Although functional status was similar at baseline, the presence of certain target conditions in this sample was associated significantly with functional decline in IADL and BADL during the 3-year period. Four conditions (gait/balance disorders, depression, unsafe home environment, and coronary artery disease) were associated with significant declines in IADL, and four conditions (gait/balance disorders, depression, hypertension, and urinary incontinence) were associated with significant declines in BADL. Conversely, subjects with obesity had no significant change in IADL or BADL throughout the study period and had less decline in IADL compared with nonobese subjects.


CONCLUSIONS
Certain chronic conditions, particularly gait/balance disorders and depression, are associated with significant decline in functional status in older persons who receive CGA. These findings may help identify older persons at risk for greatest functional decline despite participation in CGA and may also suggest the need for more effective intervention strategies in these individuals.
Cho
C Y
CY
Soonchunhyang University Department of Family Medicine, Seoul, Korea.
Alessi
C A
CA
Cho
M
M
Aronow
H U
HU
Stuck
A E
AE
Rubenstein
L Z
LZ
Beck
J C
JC
D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology* / Q000451:nursing; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000451:nursing; D005260:Female; D005684:Gait; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D005851:Geriatric Nursing; D006699:Home Care Services; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009722:Nurse Practitioners; D004856:Postural Balance; D011314:Preventive Health Services; D012307:Risk Factors