Evidence map›Paper›PMID 30208884›Full record

ArticleBMC geriatrics2018

Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex.

Colleen J Maxwell, Michael A Campitelli, Christina Diong, Luke Mondor, David B Hogan, Joseph E Amuah, Sarah Leslie, Dallas Seitz, Sudeep Gill, Kednapa Thavorn and 4 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC geriatrics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.3field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 23 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 11 institutions in 1 country.

Colleen J MaxwellSchools of Pharmacy and Public Health & Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada. colleen.maxwell@uwaterloo.ca.ORCID 0000-0002-7988-2899
Michael A CampitelliInstitute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Christina DiongInstitute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Luke MondorInstitute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
David B HoganDivision of Geriatric Medicine, Department of Medicine, University of Calgary, HSC-3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
Joseph E AmuahSchool of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
Sarah LeslieSchool of Public Health & Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON, N2L 3G1, Canada.
Dallas SeitzDivision of Geriatric Psychiatry, Queen's University & Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 4X3, Canada.
Sudeep GillDepartment of Medicine, Queen's University & Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 4X3, Canada.
Kednapa ThavornOttawa Hospital Research Institute, 501 Smyth Road, PO Box201B, Ottawa, ON, K1H 8L6, Canada.
Walter P WodchisInstitute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada.
Andrea GruneirDepartment of Family Medicine, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.
Gary TeareDepartment of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Health Science Building, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada.
Susan E BronskillInstitute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Institute for Clinical Evaluative Sciences · CAUniversity of Waterloo · CAOttawa Hospital · CAProvidence Health Care · CAQueen's University · CASaskatchewan Health · CAUniversity Health Network · CAUniversity of Alberta · CAUniversity of Calgary · CAUniversity of Ottawa · CAUniversity of Toronto · CA

Funding

CIHR MOP-136854
6 · The paper itself

Abstract

backgroundThe identification of contextual factors that modify associations between client frailty and their health and service use outcomes is essential for informed home health care and policy planning. Our objective was to examine variation in the associations between frailty and select 1-year health outcomes by caregiver distress and client sex among community-residing older care recipients.

methodsWe conducted a retrospective cohort study using linked population-based clinical and health administrative databases for all long-stay home care clients (n = 234,552) aged 66+ years assessed during April 2010-2013 in Ontario, Canada. Frailty was assessed using a previously validated 72-item frailty index (FI). Presence of caregiver distress was derived from clinical assessment items administered by trained home care assessors. Multivariable log-binomial regression models were used to examine variations in the associations between frailty and outcomes of interest (mortality, nursing home [NH] placement, all-cause and prolonged hospitalization) by caregiver distress, with further model stratification by client sex.

resultsFrailty prevalence varied little by sex (19.3% women, 19.9% men) despite significant sex-differences in clients' sociodemographic and health characteristics. In both sexes, frailty was significantly associated with all outcomes, particularly NH placement (RR = 3.84, 95%CI 3.75-3.93) and death (RR = 2.32, 95%CI 2.27-2.37), though risk ratios were greater for women. Caregiver distress was more common with increasing frailty and for male clients, and a significant independent predictor of NH placement and prolonged hospitalization in both sexes. The association between frailty and NH placement (but not other outcomes) varied by caregiver distress for both men and women (p < 0.001 interaction terms), showing a greater magnitude of association among clients without (vs. with) a distressed caregiver.

conclusionsAs caregiver distress varies by client sex, represents a key driver of NH placement (even among relatively robust clients), and modifies the impact of other risk factors such as frailty, it should be routinely assessed. Further, sex-differences should be considered when developing and evaluating community-based services for older adults and their caregivers.

Indexed as

Frail ElderlyNursing HomesAgedAged, 80 and overAnalysis of VarianceCaregiversFemaleGeriatric AssessmentHumansMaleOutcome Assessment, Health CarePrevalenceRetrospective StudiesRisk FactorsSex FactorsStress, PsychologicalCaregiver distressFrailtyGenderHome careHospitalizationMortalityNursing homeRetrospective cohortSex

Identifiers

PMID30208884
PMCPMC6134755
OpenAlexW2892340084

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.