Detecting disabilities in everyday life: evidence from a geriatric assessment

Abstract

BACKGROUND: The activities of daily living (ADL) score is a widely used index to establish the degree of independence from any help in everyday life situations. Measuring ADL accurately is time-consuming and costly. This paper presents a framework to approximate ADL via variables usually collected in comprehensive geriatric assessments. We show that the selected variables serve as good indicators in explaining the physical disabilities of older patients. METHODS: Our sample included information from a geriatric assessment of 326 patients aged between 64 and 99 years in a hospital in Tyrol, Austria. In addition to ADL, 23 variables reflecting the physical and mental status of these patients were recorded during the assessment. We performed least absolute shrinkage and selection operator (LASSO) to determine which of these variables had the highest impact on explaining ADL. Then, we used receiver operating characteristic (ROC) analysis and logistic regression techniques to validate our model performance. Finally, we calculated cut-off points for each of the selected variables to show the values at which ADL fall below a certain threshold. RESULTS: Mobility, urinary incontinence, nutritional status and cognitive function were most closely related to ADL and, therefore, to geriatric patients' functional limitations. Jointly, the selected variables were able to detect neediness with high accuracy (area under the ROC curve (AUC) = 0.89 and 0.91, respectively). If a patient had a limitation in one of these variables, the probability of everyday life disability increased with a statistically significant factor between 2.4 (nutritional status, 95%-CI 1.5-3.9) and 15.1 (urinary incontinence, 95%-CI 3.6-63.4). CONCLUSIONS: Our study highlights the most important impairments of everyday life to facilitate more efficient use of clinical resources, which in turn allows for more targeted treatment of geriatric patients. At the patient level, our approach enables early detection of functional limitations and timely indications of a possible need for assistance in everyday life.