Abstract

Background: Case management has focused on care coordination reinforcement for the very frail community-dwelling older people in order to allow them to stay at home as long as possible. However the definition of the target population eligible to have a case manager is not clear. The purpose of this study was to identify predictive factors leading to not living at home over one year in a very frail community dwelling older population.

Methods: A secondary analysis from a prospective cohort of 428 very frail older people, aged 65 years and over, living at home in Paris were set up. Patients were assessed using RAI-HC 2.0 (Resident Assessment Instrument – Home care) tool. Not living at home at one year was identified in relation with admission characteristics using logistic regressions.

Results: At baseline, a large majority of the patients lived alone with cognitive impairments and functional limitations. In one year, 48.6% (n = 208) did not live at home anymore. Among them 40.5% were dead, 36% were institutionalized and 23.5% were hospitalized and moved away. Functional disabilities for meal preparation (p = 0.04) and eating (p = 0.08), bladder incontinence (p = 0.07) and prior hospitalization (p = 0.08) increased the risk of not living at home over one year. Cognitive impairment, socio-demographic characteristics and number of home-based services were not related with the primary outcome.

Conclusion: Functional limitations and prior hospitalizations were predictive factors leading to not living at home in a very frail community dwelling older population. Results could help for identifying the population eligible to have a case manager.