Yearly transitions of disability profiles in older people living at home.
OBJECTIVE
Planning home services for older people requires extensive knowledge about the progression of disabilities. Disability-based case-mix classifications identify meaningful groups of older people; yet transitions between profiles are mostly unknown.


METHODS
Disability was assessed annually over four years with the Functional Autonomy Measurement System (SMAF) in 1410 older people at risk of functional decline aged 75 and over and living at home. The SMAF generates a case-mix classification of 14 Iso-SMAF profiles with progressive mean disability levels. Transitions made by older people were analyzed using a continuous-time, multi-state Markov model to estimate the probabilities of annual transitions into and out of each profile as well as the mean sojourn time in each profile.


RESULTS
The probability of staying in a profile tended to decrease as profile severity increased. For profiles 5 and above, recovery to mild profiles 1, 2 and 3 was low, while annual probabilities of death and institutionalization were high (>0.10). The lower disability profiles (1 and 2) evidenced a mean profile sojourn time of over two years, contrary to sojourn times of 18 months or less with the other profiles.


CONCLUSIONS
The probabilities are identifiable, indicating that a disability-based classification can characterize progression in older people. Since the required resources and costs are known for each profile, these probabilities are very helpful in planning home services for elderly populations.
Research Centre on Aging, Sherbrooke University Geriatrics Institute, 1036 Belvédère Sud, Sherbrooke, Québec J1H 4C4, Canada. michel.raiche@usherbrooke.ca
Michel
M
Raîche
Réjean
R
Hébert
Marie-France
MF
Dubois
N'deye Rokhaya
NR
Gueye
Nicole
N
Dubuc
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification; D018450:Disease Progression; D005260:Female; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012111:Residence Characteristics; D012720:Severity of Illness Index