Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults

Abstract

Background: Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people's independence trajectories and associated risk factors would enable the develop early intervention strategies.

Methods: Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011-November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the "Functional Autonomy Measurement System (Système de Mesure de l'Autonomie Fonctionnelle (SMAF))". Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory.

Results: Three distinct trajectories of independence were identified including a "Stable functional autonomy (SFA) trajectory" (53% of patients), a "Stable then decline functional autonomy decline (SDFA) trajectory" (33% of patients) and a "Constantly functional autonomy decline (CFAD) trajectory" (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD.

Conclusions: Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

Keywords: Functional decline; Independence; Older adults; Optimal number of groups; Prevention; Semi-parametric model; Trajectory.

Fig. 1

Trajectories of independence determined using the GBTM method among 221 subjects aged > 75 years in France from 2011 to 2013, benefiting a prevention strategy during the follow-up time. The best model based on the BIC value (−2424, n = 221) was the three groups model

Fig. 2

Trajectories of independence determined using the k-means method among 221 subjects aged > 75 years in France from 2011 to 2013, benefiting a prevention strategy during the follow-up time. The best model based on the Calinski-Harabasz value (378, n = 221) was the three groups model was the three groups model

Fig. 3

Trajectories of independence determined using the HAC method among 221 subjects aged > 75 years in France from 2011 to 2013, benefiting a prevention strategy during the follow-up time. The best model based on the Ward’s jump value (10, n = 221) was the three groups model