Predictors of Frailty Change in Home and Community-Based Services Populations |
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| Affiliation: | 1. Virginia Commonwealth University School of Medicine Richmond, VA, USA;2. UConn Health Center on Aging Farmington, CT, USA;3. The Lewin Group Falls Church, VA, USA;1. National Clinician Scholar Program, University of Pennsylvania, Philadelphia, PA, USA;2. Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, USA;3. Duke Margolis Center for Health Policy, Washington, DC, USA;4. National Pharmaceutical Council, Washington, DC, USA;5. University of Pennsylvania Department of Medical Ethics and Health Policy, Philadelphia, PA, USA;1. Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan;2. Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan;3. Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia;4. Center for Research, Diagnostics and Vaccine Development, Taiwan Centers for Disease Control, Taipei, Taiwan;5. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan;6. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan;7. School of Medicine, National Yang-Ming University, Taipei, Taiwan;8. Department of Neurology, Min-Sheng General Hospital, Taoyuan, Taiwan;9. Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan;10. Graduate Institute of Psychology, College of Science, National Taiwan University, Taipei, Taiwan;11. Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan |
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| Abstract: | ObjectivesWith unprecedented demand for Medicaid long-term services and supports, states are seeking to allocate resources in the most efficient way. Understanding the prevalence of frailty and how it varies across home and community-based services (HCBS) populations can assist states with more precise identification of individuals most in need of services. Early identification of individuals more likely to experience frailty changes could allow for enhanced care planning to prevent or slow the progression of decline.DesignLongitudinal study.Setting and ParticipantsData from Connecticut’s assessment tool (based on interRAI-HC) were analyzed at 2 time points for 16,309 individuals receiving HCBS. The sample included assessments completed between November 1, 2017 and July 15, 2020 across 4 groups: older adults 65+ years old meeting nursing facility level of care (NF LOC), older adults 65+ years old not meeting NF LOC, individuals with acquired brain injury, and individuals <65 years old with physical disability.MethodsWe measured frailty using the Frailty Index (FI) and examined change in FI between baseline and follow-up. A change in FI score of at least ±0.03 was classified as a clinically meaningful change. We compared predictors of clinically meaningful decline or improvement using multivariate logistic regression.ResultsIn our sample, 54% of individuals experienced a clinically meaningful change: 42% declined and 12% improved. Individuals receiving in-home care services had lower odds of improvement across all HCBS groups and multiple frailty categories with odds ratios ranging from 0.35 to 0.68. Frail older adults 65+ years old meeting nursing facility level of care receiving physical therapy were 21% less likely to experience decline and 1.4 times more likely to improve.Conclusions and ImplicationsThe nature of HCBS support provided can impact changes in frailty status. More reactive services such as in-home care may contribute to frailty decline while rehabilitative services such as physical therapy may protect against decline. |
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| Keywords: | HCBS LTSS Transitions waivers Medicaid interRAI-HC RAI-HC |
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