The Development of a Model to Predict Cognitive Decline Within 12 Months in Home Care Clients.

IF 3.2 3区医学 Q1 NURSING

Journal of Clinical Nursing Pub Date : 2025-03-18 DOI:10.1111/jocn.17726

Gary Cheung, Ruth Teh, Eamon Merrick, Nicole Williams, Dawn M Guthrie

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引用次数: 0

Abstract

Aim: To develop and validate a model to predict cognitive decline within 12 months for home care clients without a diagnosis of dementia.

Design: We included all adults aged ≥ 18 years who had at least two interRAI Home Care assessments within 12 months, no diagnosis of dementia and a baseline Cognitive Performance Scale score ≤ 1. The sample was randomly split into a derivation cohort (75%) and a validation cohort (25%). Significant cognitive decline was defined as an increase (deterioration) in Cognitive Performance Scale scores from '0' or '1' at baseline to a score of ≥ 2 at the follow-up assessment.

Methods: Using the derivation cohort, a multivariable logistic regression model was used to predict cognitive decline within 12 months. Covariates included demographics, disease diagnoses, sensory and communication impairments, health conditions, physical and social functioning, service utilisation, informal caregiver status and eight interRAI-derived health index scales. The predicted probability of cognitive decline was calculated for each person in the validation cohort. The c-statistic was used to assess the model's discriminative ability. This study followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) reporting guidelines.

Results: A total of 6796 individuals (median age: 82; female: 60.4%) were split into a derivation cohort (n = 5098) and a validation cohort (n = 1698). Logistic regression models using the derivation cohort resulted in a c-statistic of 0.70 (95% CI 0.70, 0.73). The final regression model (including 21 main effects and 8 significant interaction terms) was applied to the validation cohort, resulting in a c-statistic of 0.69 (95% CI 0.66, 0.72).

Conclusion: interRAI data can be used to develop a model for identifying individuals at risk of cognitive decline. Identifying this group enables proactive clinical interventions and care planning, potentially improving their outcomes. While these results are promising, the model's moderate discriminative ability highlights opportunities for improvement.

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一个模型的发展，以预测认知衰退在12个月内的家庭护理客户。

目的：开发和验证一个模型来预测12个月内认知能力下降的家庭护理客户没有诊断痴呆。设计：我们纳入了所有年龄≥18岁的成年人，他们在12个月内至少进行了两次rai家庭护理评估，没有诊断出痴呆，基线认知表现量表评分≤1。样本随机分为衍生组（75%）和验证组（25%）。显著的认知能力下降定义为认知表现量表得分从基线时的“0”或“1”增加（恶化）到随访评估时的得分≥2。方法：采用衍生队列，采用多变量logistic回归模型预测12个月内认知能力下降。协变量包括人口统计、疾病诊断、感觉和沟通障碍、健康状况、身体和社会功能、服务利用、非正式照顾者状况和八个由rai衍生的健康指数量表。对验证队列中每个人的认知能力下降的预测概率进行计算。使用c统计量来评估模型的判别能力。本研究遵循个体预后或诊断多变量预测模型透明报告（TRIPOD）报告指南。结果：共6796例(中位年龄：82岁；女性：60.4%)被分为衍生队列（n = 5098）和验证队列（n = 1698）。使用衍生队列的Logistic回归模型的c统计量为0.70 （95% CI 0.70, 0.73）。将最终回归模型（包括21个主效应和8个显著交互项）应用于验证队列，其c统计量为0.69 （95% CI 0.66, 0.72）。结论：interRAI数据可用于开发识别认知能力下降风险个体的模型。确定这一群体可以使积极的临床干预和护理计划，潜在地改善他们的结果。虽然这些结果是有希望的，但该模型的适度判别能力突出了改进的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Nursing 医学-护理

CiteScore

6.40

自引率

2.40%

发文量

审稿时长

2 months

期刊介绍： The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice. JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice. We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.