A Study of Frailty, Mortality, and Health Depreciation Factors in Older Adults.

This study used 23 factors (eight interval variables and 15 dummy variables) as proxies for health depreciation. We used 1248 older adults from the Center for Geriatrics and Gerontology of Taichung Veterans General Hospital (Taiwan) to examine the association among frailty, health depreciation, and mortality in older adults. This study found that a significant positive correlation existed between frailty and mortality in older adults. Further, we applied a recursive bivariate probit model to examine the association between health depreciation factors, frailty, and mortality. Our results showed that health depreciation factors, such as Charlson's comorbidity index, diabetes and hyperlipidemia, significantly increased older adults' frailty; in contrast, albumin and mini nutritional assessment significantly decreased older adults' frailty. Through the frailty regression, we confirmed not only that health depreciation factors significantly influenced mortality, but also that creatinine, myocardial infarction, and malignant tumors could directly and significantly increase older adults' mortality.

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

Application of qualitative response models in a relevance study of older adults' health depreciation and medical care demand.

AIM: The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation. METHODS: All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end-point of rehospitalization within 14 days, re-admission to the emergency department within 3 days and patient death. RESULTS: Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = -0.35, P < 0.001 in Poisson regression; coefficient = -0.33, P < 0.001 in order choice profit model; coefficient = -0.29, P < 0.001 in binary choice profit model). The major determinants for poor outcome were male sex, middle old age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education. CONCLUSIONS: An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645-652.