title: Who will need long-term care? Creation and validation of an instrument that identifies older people at risk.
abstract: The aim of this study was to create and measure the predictive validity of a screening instrument that identifies older people who are at risk for developing a need for long-term care within a year. This was an observational study, with participants allocated to either a derivation cohort or a validation cohort, in the United States. A nationally representative sample of older community-dwelling Medicare beneficiaries (n = 6,538) participated in the Medicare Current Beneficiary Survey. Questions addressed sociodemographic, functional, health-related, and utilization characteristics in 1991 and 1992, linked to records of Medicare payments for health services during 1991-1992. In the derivation cohort, 14 self-reported characteristics were significant predictors of developing a need for long-term care within 1 year. In the validation cohort, these 14 characteristics identified a high-risk subgroup (18%) that, during the following year, developed a need for long-term care at six times the rate of the low-risk majority. This brief survey instrument identifies a high-risk minority of older people that will, during the following year, develop a need for long-term care at six times the rate of the low-risk majority. This instrument may be useful for targeting at-risk subgroups of older populations to receive interventions designed to preserve functional independence and avert the need for long-term care.
authors.affiliation: Institute for Health Care Delivery Research, Salt Lake City, Utah 84111, USA. sarah.goodlin@ihc.com
authors.forename: Sarah
authors.initials: S
authors.lastname: Goodlin
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
authors.forename: Thomas
authors.initials: T
authors.lastname: Bubolz
authors.forename: Lillian
authors.initials: L
authors.lastname: Chiang
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D015577:Geriatric Assessment / Q000379:methods*; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000639:trends*; D006304:Health Status; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012866:Skilled Nursing Facilities / Q000191:economics / Q000706:statistics & numerical data; D014481:United States