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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
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Population-Based Screening for Functional Disability in Older Adults.

Claire K Ankuda1, Vicki A Freedman2, Kenneth E Covinsky3,4

  • 1Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Innovation in Aging
|January 28, 2021
PubMed
Summary

Screening older adults for activities of daily living (ADL) disability and life space constriction (LSC) effectively predicts mortality and hospitalization. Combining both measures offers the most accurate risk identification for high-need individuals.

Keywords:
AgingFunctional assessmentHealth services researchPublic health

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Area of Science:

  • Gerontology
  • Public Health
  • Healthcare Management

Background:

  • Functional disability screening is crucial for identifying at-risk older adults.
  • Activities of Daily Living (ADL) and Life Space Constriction (LSC) are key indicators of functional status.

Purpose of the Study:

  • To compare the predictive power of ADL disability and LSC for hospitalization and mortality in older adults.
  • To evaluate the combined predictive value of ADL and LSC for adverse health outcomes.

Main Methods:

  • Utilized the National Health and Aging Trends Study dataset (30,885 observations, adults aged 65+).
  • Assessed ADL disability (need for help with basic self-care) and LSC (frequency of leaving home).
  • Analyzed 1-year rates of mortality and hospitalization as primary outcomes.

Main Results:

  • Both ADL disability (12.4% reporting 3+ ADLs) and LSC (10.8% rarely/never leaving home) significantly predicted mortality and hospitalization.
  • Individuals with both severe ADL disability and LSC had the highest mortality rate (58.4%).
  • Combined screening for ADL and LSC was more predictive than either measure alone, identifying distinct high-risk populations.

Conclusions:

  • ADL disability and LSC independently predict mortality and hospitalization in older adults.
  • Using both ADL and LSC screening measures provides the most accurate prediction of adverse health outcomes.
  • Routine screening for ADLs and LSC can enhance health systems' ability to identify and manage high-risk older adults.