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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Geriatrics 1/2014

Natural course of care dependency in residents of long-term care facilities: prospective follow-up study

BMC Geriatrics > Ausgabe 1/2014
Monique AA Caljouw, Herman JM Cools, Jacobijn Gussekloo
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2318-14-67) contains supplementary material, which is available to authorized users.

Competing interest

All researchers worked independently from the funders. The authors declare that they have no competing interests.

Authors’ contributions

MAAC, HJMC and JG contributed to the study concept and design, acquisition of data, analysis and interpretation of the data, drafting of the manuscript and critical revision of the manuscript. All authors read and approved the final version of the manuscript.



Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality.


A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79–88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15–75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months.


At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P < 0.001); participants in the low CDS group stayed longer, had more frequent urine incontinence and more dementia. They had also the highest mortality rate (log rank 32.2; df = 2; P for trend <0.001). Per point lower in CDS score, the mortality risk increased with 2% (95% CI 1%-3%). Adjustment for age, gender, cranberry use, LTCF, length of stay, comorbidity and dementia showed similar results. A one point decrease in CDS score between 0 and 6 months was related to an increased mortality risk of 4% (95% CI 3%-6%).
At the 6-month follow-up, 10% improved to a higher CDS group, 65% were in the same, and 25% had deteriorated to a lower CDS group; a similar pattern emerged at 12-month follow-up. Gender, age, urine incontinence, dementia, cancer and baseline care dependency status, predicted an increase in care dependency over time.


The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.
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