Background
Methods
Participants and study design
Value-based health metrics
Other variables
Statistical analysis
Results
Participant characteristics
Data values show mean ± standard deviation or number (percent) | Entire cohort | Value-based health status | p | |
---|---|---|---|---|
Low (< 8/10) | High (≥8/10) | |||
Number | 299 | 210 | 89 | |
ICHOM Standard Set Older Person Tier 1 | ||||
Clinical frailty scale | 2.7 ± 0.9 | 2.8 ± 1.0 | 2.3 ± 0.7 | < 0.001 |
Frail | 35 (11.7) | 35 (16.7) | 0 (0.0) | < 0.001 |
Preferred place of death chosen | 43 (14.4) | 25 (11.9) | 18 (20.2) | 0.061 |
Do Not Resuscitate signed | 21 (7.0) | 11 (5.2) | 10 (11.2) | 0.064 |
ICHOM Standard Set Older Person Tier 2 | ||||
Number of drugs | 3.6 ± 2.7 | 4.3 ± 2.7 | 2.0 ± 1.7 | < 0.001 |
Polypharmacy (≥5 concurrent drugs) | 95 (31.8) | 90 (42.8) | 5 (5.6) | < 0.001 |
Number of adverse drug events in past 12 months | 0.0 ± 0.1 | 0.0 ± 0.2 | 0.0 ± 0.0 | 0.180 |
Episodes of discomfort after medications in past 12 months | 0.0 ± 0.1 | 0.0 ± 0.2 | 0.0 ± 0.0 | 0.103 |
Fell in past 12 months | 51 (17.1) | 50 (23.8) | 1 (1.1) | < 0.001 |
Number of falls in past 12 months | 0.2 ± 0.6 | 0.3 ± 0.7 | 0.0 ± 0.1 | < 0.001 |
Hospital admissions in past 12 months | 0.2 ± 0.4 | 0.2 ± 0.5 | 0.1 ± 0.3 | 0.004 |
Length of hospital stay (days) | 1.1 ± 3.7 | 1.4 ± 4.3 | 0.5 ± 1.8 | 0.009 |
Able to cope with own health | 276 (92.3) | 187 (89.1) | 89 (100.0) | 0.001 |
Participate in care decision-making | 276 (92.3) | 188 (89.5) | 88 (98.9) | 0.006 |
Treated with dignity and respect | 289 (96.7) | 200 (95.2) | 89 (100.0) | 0.036 |
Received coordinated care | 270 (90.3) | 181 (86.2) | 89 (100.0) | < 0.001 |
Discharged to place of choice | 296 (99.0) | 207 (98.6) | 89 (100.0) | 0.257 |
Overall participation in decision-making | 4.7 ± 0.7 | 4.6 ± 0.9 | 5.0 ± 0.1 | < 0.001 |
High participation (≥5) | 244 (81.6) | 156 (74.3) | 88 (98.9) | < 0.001 |
ICHOM Standard Set Older Person Tier 3 | ||||
UCLA Loneliness Scale | 31.0 ± 10.0 | 33.4 ± 11.0 | 25.3 ± 3.0 | < 0.001 |
Loneliness | 80 (26.8) | 80 (38.1) | 0 (0.0) | < 0.001 |
Activities of daily living | 7.4 ± 1.4 | 7.2 ± 1.6 | 8.0 ± 0.3 | < 0.001 |
Any limitation of activities of daily living | 67 (22.4) | 66 (31.4) | 1 (1.1) | < 0.001 |
Walking speed (m/s) | 0.9 ± 0.3 | 0.8 ± 0.3 | 1.1 ± 0.2 | < 0.001 |
Slowness (6-m walk < 0.8 m/s) | 115 (38.5) | 114 (54.3) | 1 (1.1) | < 0.001 |
Moderate pain | 31 (10.4) | 30 (14.3) | 1 (1.1) | < 0.001 |
Depression | 39 (13.0) | 39 (18.6) | 0 (0.0) | < 0.001 |
Value-based healthcare score | 7.2 ± 1.8 | 6.5 ± 1.6 | 9.1 ± 0.3 | < 0.001 |
High value-based healthcare | 89 (29.8) | 0 | 89 (100) | < 0.001 |
Data values show mean ± standard deviation or number (percent) | Entire cohort | Value-based health status | p | |
---|---|---|---|---|
Low (< 8/10) | High (≥8/10) | |||
Demographics and health-related factors | ||||
Number | 299 | 210 | 89 | |
Age (years) | 73.3 ± 6.6 | 74.0 ± 6.9 | 71.5 ± 5.7 | 0.002 |
Male | 122 (40.8) | 93 (44.3) | 29 (32.6) | 0.060 |
Education (years) | 7.6 ± 4.7 | 7.3 ± 4.7 | 8.3 ± 4.6 | 0.063 |
Smoke tobacco | 44 (14.7) | 36 (17.1) | 8 (9.0) | 0.069 |
Drink alcohol | 37 (12.4) | 27 (12.9) | 10 (11.2) | 0.697 |
Exercise | 51 (17.1) | 34 (16.2) | 17 (19.1) | 0.541 |
Montreal Cognitive Assessment (adjusted)a | 23.8 ± 5.6 | 22.8 ± 5.9 | 26.2 ± 3.8 | < 0.001 |
Montreal Cognitive Assessment (adjusted)a < 26 | 154 (51.5) | 122 (58.1) | 32 (36.0) | < 0.001 |
Charlson Comorbidity Index | 1.1 ± 1.0 | 1.3 ± 1.1 | 0.9 ± 1.0 | 0.002 |
Charlson Comorbidity Index ≥2 | 90 (30.1) | 74 (35.2) | 16 (18.0) | 0.003 |
Body mass index | 25.3 ± 3.6 | 25.2 ± 3.8 | 25.3 ± 3.1 | 0.797 |
Subgroup comparisons
Data values show mean ± standard deviation or number (percent) | Sex | Age (years) | MoCAadj | ||||||
---|---|---|---|---|---|---|---|---|---|
Female | Male | p | < 75 | ≥75 | p | ≥26 | < 26 | p | |
Demographics and health-related factors | |||||||||
Number | 177 | 122 | 184 | 115 | 145 | 154 | |||
Age (years) | 73.3 ± 6.3 | 73.3 ± 7.0 | 0.957 | 68.9 ± 2.7 | 80.3 ± 4.6 | < 0.001 | 71.3 ± 5.5 | 75.1 ± 7.0 | < 0.001 |
Male | 0 (0) | 122 (100) | < 0.001 | 75 (40.8) | 47 (40.9) | 0.985 | 57 (39.3) | 65 (42.2) | 0.61 |
Education (years) | 6.9 ± 4.4 | 8.8 ± 4.8 | 0.001 | 8.3 ± 4.3 | 6.5 ± 5.0 | 0.001 | 9.3 ± 4.0 | 6.0 ± 4.7 | < 0.001 |
Smoke tobacco | 6 (3.4) | 38 (31.2) | < 0.001 | 29 (15.8) | 15 (13.0) | 0.519 | 21 (14.5) | 23 (14.9) | 0.912 |
Drink alcohol | 7 (4.0) | 30 (24.6) | < 0.001 | 25 (13.6) | 12 (10.4) | 0.421 | 24 (16.6) | 13 (8.4) | 0.033 |
Exercise (≥30 min, ≥3 times/week) | 31 (17.5) | 20 (16.4) | 0.8 | 37 (20.1) | 14 (12.2) | 0.076 | 24 (16.6) | 27 (17.5) | 0.822 |
Montreal Cognitive Assessment (adjusted)a | 23.8 ± 5.5 | 23.7 ± 5.6 | 0.778 | 25.2 ± 4.6 | 21.5 ± 6.2 | < 0.001 | 28.2 ± 1.6 | 19.5 ± 4.6 | < 0.001 |
Montreal Cognitive Assessment (adjusted)a < 26 | 89 (50.3) | 65 (53.3) | 0.61 | 75 (40.8) | 79 (68.7) | < 0.001 | 0 (0.0) | 154 (100.0) | < 0.001 |
Charlson Comorbidity Index | 1.1 ± 1.1 | 1.2 ± 1.0 | 0.722 | 1.2 ± 1.0 | 1.1 ± 1.1 | 0.517 | 1.1 ± 1.0 | 1.2 ± 1.1 | 0.237 |
Charlson Comorbidity Index ≥2 | 48 (27.1) | 42 (34.4) | 0.176 | 60 (32.6) | 30 (26.1) | 0.232 | 42 (29.0) | 48 (31.2) | 0.678 |
Body mass index (kg/m2) | 24.9 ± 3.7 | 25.8 ± 3.5 | 0.039 | 25.8 ± 3.4 | 24.4 ± 3.9 | 0.002 | 25.3 ± 3.3 | 25.2 ± 3.9 | 0.930 |
ICHOM Standard Set Older Person Tier 1 | |||||||||
Clinical frailty scale | 2.6 ± 0.9 | 2.7 ± 1.0 | 0.838 | 2.5 ± 0.8 | 3.0 ± 1.0 | < 0.001 | 2.5 ± 0.7 | 2.8 ± 1.1 | < 0.001 |
Frail | 22 (12.4) | 13 (10.7) | 0.639 | 13 (7.1) | 22 (19.1) | 0.002 | 5 (3.5) | 30 (19.5) | < 0.001 |
Preferred place of death chosen | 30 (17.0) | 13 (10.7) | 0.128 | 29 (15.8) | 14 (12.2) | 0.390 | 19 (13.1) | 24 (15.6) | 0.541 |
Do Not Resuscitate signed | 15 (8.5) | 6 (4.9) | 0.237 | 17 (9.2) | 4 (3.5) | 0.058 | 15 (10.3) | 6 (3.9) | 0.029 |
ICHOM Standard Set Older Person Tier 2 | |||||||||
Number of drugs | 3.4 ± 2.6 | 3.8 ± 2.7 | 0.207 | 3.2 ± 2.6 | 4.2 ± 2.7 | 0.001 | 3.5 ± 2.7 | 3.7 ± 2.7 | 0.436 |
Polypharmacy (≥5 concurrent drugs) | 53 (29.9) | 42 (34.4) | 0.413 | 49 (26.6) | 46 (40.0) | 0.016 | 43 (29.7) | 52 (33.8) | 0.445 |
Number of adverse drug events | 0.0 ± 0.2 | 0.0 ± 0.1 | 0.839 | 0.0 ± 0.2 | 0.0 ± 0.0 | 0.289 | 0.0 ± 0.2 | 0.0 ± 0.0 | 0.181 |
Episodes of discomfort after medications | 0.0 ± 0.2 | 0.0 ± 0.1 | 0.599 | 0.0 ± 0.2 | 0.0 ± 0.0 | 0.103 | 0.0 ± 0.2 | 0.0 ± 0.0 | 0.103 |
Fell | 34 (19.2) | 17 (13.9) | 0.233 | 27 (14.7) | 24 (20.9) | 0.166 | 24 (16.6) | 27 (17.5) | 0.822 |
Number of falls | 0.3 ± 0.6 | 0.2 ± 0.5 | 0.131 | 0.2 ± 0.6 | 0.2 ± 0.5 | 0.672 | 0.2 ± 0.6 | 0.2 ± 0.6 | 0.877 |
Hospital admissions | 0.1 ± 0.3 | 0.3 ± 0.6 | < 0.001 | 0.2 ± 0.5 | 0.2 ± 0.4 | 0.871 | 0.2 ± 0.4 | 0.2 ± 0.5 | 0.657 |
Length of hospital stay (days) | 0.5 ± 2.6 | 2.0 ± 4.8 | 0.003 | 1.0 ± 3.5 | 1.3 ± 4.1 | 0.486 | 0.9 ± 2.7 | 1.3 ± 4.5 | 0.286 |
Able to cope with own health | 162 (91.5) | 114 (93.4) | 0.541 | 172 (93.5) | 104 (90.4) | 0.337 | 138 (95.2) | 138 (89.6) | 0.071 |
Participate in care decision-making | 163 (92.1) | 113 (92.6) | 0.865 | 168 (91.3) | 108 (93.9) | 0.410 | 135 (93.1) | 141 (91.6) | 0.616 |
Treated with dignity and respect | 170 (96.1) | 119 (97.5) | 0.48 | 178 (96.7) | 111 (96.5) | 0.919 | 142 (97.9) | 147 (95.5) | 0.234 |
Received coordinated care | 163 (92.1) | 107 (87.7) | 0.208 | 159 (86.4) | 111 (96.5) | 0.004 | 132 (91.0) | 138 (89.6) | 0.678 |
Discharged to place of choice | 176 (99.4) | 120 (98.4) | 0.36 | 183 (99.5) | 113 (98.3) | 0.313 | 144 (99.3) | 152 (98.7) | 0.597 |
Overall participation in decision-making | 4.7 ± 0.8 | 4.7 ± 0.7 | 0.863 | 4.7 ± 0.8 | 4.8 ± 0.7 | 0.353 | 4.8 ± 0.6 | 4.6 ± 0.8 | 0.175 |
High participation (≥5 components) | 150 (84.8) | 94 (77.1) | 0.091 | 147 (79.9) | 97 (84.4) | 0.333 | 122 (84.1) | 122 (79.2) | 0.273 |
ICHOM Standard Set Older Person Tier 3 | |||||||||
UCLA Loneliness Scale | 30.7 ± 10.2 | 31.3 ± 9.8 | 0.611 | 30.4 ± 9.4 | 31.8 ± 11.0 | 0.232 | 28.4 ± 8.3 | 33.4 ± 11.0 | < 0.001 |
Loneliness | 46 (26.0) | 34 (27.9) | 0.718 | 46 (25.0) | 34 (29.6) | 0.386 | 22 (15.2) | 58 (37.7) | < 0.001 |
Activities of daily living | 7.5 ± 1.3 | 7.2 ± 1.5 | 0.08 | 7.6 ± 1.1 | 7.1 ± 1.7 | 0.002 | 7.8 ± 0.8 | 7.1 ± 1.8 | < 0.001 |
Any limitation of activities of daily living | 29 (16.4) | 38 (31.2) | 0.003 | 29 (15.8) | 38 (33.0) | < 0.001 | 19 (13.1) | 48 (31.2) | < 0.001 |
Walking speed (m/s) | 0.9 ± 0.3 | 0.9 ± 0.3 | 0.514 | 0.9 ± 0.3 | 0.8 ± 0.3 | < 0.001 | 1.0 ± 0.2 | 0.8 ± 0.3 | < 0.001 |
Slowness (6-m walk < 0.8 m/s) | 68 (38.4) | 47 (38.5) | 0.985 | 54 (29.4) | 61 (53.0) | < 0.001 | 32 (22.1) | 83 (53.9) | < 0.001 |
Moderate pain | 21 (11.9) | 10 (8.2) | 0.307 | 15 (8.2) | 16 (13.9) | 0.112 | 16 (11.0) | 15 (9.7) | 0.714 |
Depression | 25 (14.1) | 14 (11.5) | 0.504 | 19 (10.3) | 20 (17.4) | 0.078 | 16 (11.0) | 23 (14.9) | 0.317 |
Value-based health score | 7.3 ± 1.9 | 7.1 ± 1.8 | 0.312 | 7.6 ± 1.6 | 6.7 ± 2.1 | < 0.001 | 7.8 ± 1.5 | 6.8 ± 2.0 | < 0.001 |
High value-based health | 60 (33.9) | 29 (23.8) | 0.06 | 63 (34.2) | 26 (22.6) | 0.032 | 57 (39.3) | 32 (20.8) | 0.001 |
Linear and logistic regression analyses
Univariable | Multivariable | |||||
---|---|---|---|---|---|---|
β coefficient | p | β coefficienta | p | β coefficientb | p | |
Age (years) | −0.096 | < 0.001 | −0.050 | 0.001 | −0.079 | < 0.001 |
Male | −0.196 | 0.364 | ||||
Education (years) | 0.080 | < 0.001 | 0.002 | 0.921 | 0.035 | 0.110 |
Smoke tobacco | −0.480 | 0.105 | ||||
Drink alcohol | 0.034 | 0.917 | ||||
Exercise | 0.340 | 0.231 | 0.170 | 0.488 | 0.161 | 0.525 |
CCI | −0.366 | < 0.001 | −0.297 | 0.001 | ||
CCI ≥2 | −0.845 | < 0.001 | −0.832 | < 0.001 | ||
MoCAadj | 0.155 | < 0.001 | 0.129 | < 0.001 | ||
MoCAadj < 26 | −0.998 | < 0.001 | −0.591 | 0.005 | ||
Body Mass Index | 0.058 | 0.048 | 0.038 | 0.135 | 0.032 | 0.237 |
Univariable | Multivariable | |||||
---|---|---|---|---|---|---|
Odds ratio (95% CI) | p | Odds ratio (95% CI)a | p | Odds ratio (95% CI)b | p | |
Age (years) | 0.94 (0.90, 0.98) | 0.003 | 0.97 (0.92, 1.02) | 0.176 | 0.95 (0.91, 0.99) | 0.025 |
Male | 0.61 (0.36, 1.02) | 0.061 | 0.69 (0.37,1.28) | 0.241 | 0.70 (0.38, 1.29) | 0.257 |
Education (years) | 1.05 (0.99, 1.11) | 0.092 | 0.99 (0.93, 1.06) | 0.783 | 1.02 (0.96, 1.09) | 0.593 |
Smoke tobacco | 0.48 (0.21, 1.07) | 0.074 | 0.57 (0.23, 1.42) | 0.228 | 0.53 (0.21, 1.32) | 0.172 |
Drink alcohol | 0.86 (0.40, 1.86) | 0.697 | ||||
Exercise | 1.22 (0.64, 2.33) | 0.541 | ||||
CCI | 0.65 (0.49, 0.85) | 0.002 | 0.66 (0.49, 0.89) | 0.006 | ||
CCI ≥2 | 0.40 (0.22, 0.74) | 0.004 | 0.40 (0.21, 0.76) | 0.005 | ||
MoCAadj | 1.15 (1.08, 1.22) | < 0.001 | 1.15 (1.07, 1.23) | < 0.001 | ||
MoCAadj < 26 | 0.41 (0.24, 0.68) | 0.001 | 0.49 (0.27, 0.87) | 0.014 | ||
Body Mass Index | 1.01 (0.94, 1.08) | 0.813 |