Predicting functional decline in community-living older people with a low socioeconomic status.

Abstract

Background: Maintaining independence is one of the most important goals of the majority of older people. The onset of disability in activities of daily living is one of the greatest threats to the ability of older people to live independently. Older people with a low socioeconomic status are at high risk of functional decline. It is unclear what predicts functional decline in older people with a low socioeconomic status. Aim: To determine predictors of 12-month functional decline in community-living older people (≥60 years) with low socioeconomic status. Method: A prognostic multicentre study was conducted, using data from The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS). A multivariable logistic regression model was fitted, using a stepwise backward selection process. Performance of the model was expressed by discrimination, calibration and accuracy. Results: 5.718 participants were included. The mean age of the participants was 78.8 years and 3.357 participants (58.7%) were female. Functional decline was present in 1.904 participants (33.3%). Ten predictors were found in the multivariable analysis, of which the presence of dementia (OR 3.20, 95% CI 2.36-4.35) and age (OR 1.06, 95% CI 1.05-1.08) were the strongest predictors. Other predictors were educational level, arthrosis/arthritis, hearing problems, multimorbidity, reasonable/poor health, quality of life rate, some/little hampering social activities and receiving home care. The final prediction model showed an acceptable discrimination (C-statistic 0.69, 95% CI 0.67-0.70), calibration (Hosmer-Lemeshow p-value 0.33) and accuracy (Brier score 0.20). Conclusion: This secondary analysis provides insight in the predictors of 12-month functional decline in community-living older people with a low SES. Recommendations: Further research is needed to examine how functional decline can be ameliorated and substantial improvements by tailored interventions can be achieved within this subgroup.