Paudel, Y. R.

Determinants of Health Utilities Index Mark 3 trajectory among residents of long-term care facilities
Paudel, Y.R., Jhangri, G.S., Feeny, D., Ickert, C., Slaughter, S., & Jones, C.A.

Health status of residents in long-term care (LTC) facilities is an understudied area, in spite of a high prevalence of functional dependency, cognitive impairment and multi-morbidity. We aimed to identify resident-related determinants that predict the 6 month trajectory of health status (Health Utilities Index Mark 3; HUI3) in residents with dementia from LTC facilities.

This was a longitudinal quasi-experimental study of a sit to stand functional activity for 122 participants with dementia from 7 LTC facilities in Edmonton, Canada. Overall health status (HUI3), function (Resident Assessment Instrument-Minimum Data Set 2.0 scales (RAI-MDS 2.0), quality of life (Quality of Life Alzheimer's Disease, QoL-AD) and medical instability (MDS-CHESS) were measured at baseline, 3-months and 6-months. Direct care providers for each participant completed the measures. Hot-deck multiple imputations were performed for missing HUI3 single attribute scores. A linear mixed model was used to identify baseline factors associated with the trajectory for the HUI3. Age, sex and intervention group status were adjusted in the model.

The mean HUI3 overall scores at baseline, 3 mos and 6 mos were 0.28(SD 0.27), 0.24(SD 0.29), and 0.21(SD 0.29). No significant or clinically important differences on HUI3 trajectory were seen between groups (coeff 0.04,95% CI: -0.01,0.1).A clinically important decrease of the HUI3 score (mean 0.037,95% CI: -0.07,-0.01,p=0.007) was seen at each follow-up time point.Mean baseline values for the MDS-ADL long scale and QoL-AD were 13.9 (SD 5.8) and 38.1 (SD 8.4), respectively. Baseline MDS-ADL long scale (coeff-0.0056, 95%CI -0.010, -0.0002;p=0.04) and QoL-AD (coeff-0.006, 95%CI -0.010, -0.003, p=0.001) were significantly associated with the HUI3 trajectory. Although MDS-CHESS was associated with the HUI3 trajectory in the univariate model, it did not reach statistical significance in the multivariable model.

Baseline scores of QoL-AD and MDS-ADL long scale can be used to identify residents with dementia at risk of declining health status.