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 func tional status change during a 3-year period in older people enrolled i n an in-home comprehensive geriatric assessment (CGA) and preventive c are program. DESIGN: Secondary analysis of data from a longitudinal co hort study. SETTING: Santa Monica, California. PARTICIPANTS: Two hundr ed two community-dwelling older persons (mean age at baseline was 81 y ears, 70% were women, and 72% reported good health) randomized to the intervention group in a trial of in-home comprehensive geriatric asses sment and preventive care. MEASUREMENTS: We studied 13 common chronic illnesses/conditions determined clinically from an annual comprehensiv e evaluation by gerontologic nurse practitioners (GNPs) in consultatio n with study geriatricians. These target conditions included hypertens ion, 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 instrumen tal activities of daily living (IADL) and basic activities of daily li ving (BADL) assessed at baseline and annually for 3 years by independe nt research personnel. Potential confounding variables, including como rbid conditions and other subject characteristics, were controlled for in the analyses. RESULTS: Although functional status was similar at b aseline, the presence of certain target conditions in this sample was associated significantly with functional decline in IADL and BADL duri ng the 3-year period. Four conditions (gait/balance disorders, depress ion, unsafe home environment, and coronary artery disease) were associ ated with significant declines in IADL, and four conditions (gait/bala nce disorders, depression, hypertension, and urinary incontinence) wer e associated with significant declines in BADL. Conversely, subjects w ith obesity had no significant change in IADL or BADL throughout the s tudy period and had less decline in IADL compared with nonobese subjec ts. 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 d espite participation in CGA and may also suggest the need for more eff ective intervention strategies in these individuals.