title: Application of qualitative response models in a relevance study of older adults' health depreciation and medical care demand.
abstract: OBJECTIVE
  The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation.
  
  
  METHODS
  All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end-point of rehospitalization within 14 days, re-admission to the emergency department within 3 days and patient death.
  
  
  RESULTS
  Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = -0.35, P < 0.001 in Poisson regression; coefficient = -0.33, P < 0.001 in order choice profit model; coefficient = -0.29, P < 0.001 in binary choice profit model). The major determinants for poor outcome were male sex, middle old age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education.
  
  
  CONCLUSIONS
  An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645-652.
authors.affiliation: Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.|Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Clinical Medicine, School of Nursing, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shuo-Chun
authors.initials: SC
authors.lastname: Weng
authors.affiliation: Department and Institute of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Chi
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of International Business, Tunghai University, Taichung, Taiwan.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Clinical Medicine, School of Nursing, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yuan-Yang
authors.initials: YY
authors.lastname: Cheng
authors.affiliation: Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Yih-Jing
authors.initials: YJ
authors.lastname: Tang
authors.affiliation: Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Department of International Business, Tunghai University, Taichung, Taiwan.
authors.forename: Jwu-Rong
authors.initials: JR
authors.lastname: Lin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D011446:Prospective Studies
keywords: composite end-points; comprehensive geriatric assessment; health depreciation; medical care; qualitative response model