PREDICTING OUTCOMES OF COMMUNITY-BASED CONTINUING CARE - 4-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 continui ng care nurses; to determine the rates of functional impairment in eld erly community-based continuing care clients; to describe long-term gr oup trends in this population. DESIGN A prospective cohort study, whic h lasted 4 years. SETTING Community-based continuing care nursing prog ram. PARTICIPANTS Two hundred thirty-seven elderly (65 years or older) clients of the program. MAIN OUTCOME MEASURES Activities of daily liv ing (ADL), cognitive function, and affective function were assessed wh en clients entered the program (using the Barthel Index, the Canadian Mental Status Questionnaire, and the Memorial University Scale of Happ iness). Home care nurses were asked to predict whether individual clie nts would have died or dropped out of the program at 1 year after entr y. RESULTS Cognitive function and ADL function tests were significant predictors of both death and drop-out from the program; they were bett er 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 wer e still receiving continuing care. CONCLUSIONS Functional assessment o f cognitive and ADL domains was a better predictor of outcomes than cl inical judgment. Studying the cohort enabled us to describe group tren ds, which could be valuable for program managers.