Prediction models for functional status in community dwelling older adults: a systematic review. 2022

Bastiaan Van Grootven, and Theo van Achterberg
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.

Disability poses a burden for older persons, and is associated with poor outcomes and high societal costs. Prediction models could potentially identify persons who are at risk for disability. An up to date review of such models is missing. To identify models developed for the prediction of functional status in community dwelling older persons. A systematic review was performed including studies of older persons that developed and/or validated prediction models for the outcome functional status. Medline and EMBASE were searched, and reference lists and prospective citations were screened for additional references. Risk of bias was assessed using the PROBAST-tool. The performance of models was described and summarized, and the use of predictors was collated using the bag-of-words text mining procedure. Forty-three studies were included and reported 167 evaluations of prediction models. The median c-statistic values for the multivariable development models ranged between 0.65 and 0.76 (minimum = 0.58, maximum = 0.90), and were consistently higher than the values of the validation models for which median c-statistic values ranged between 0.6 and 0.68 (minimum = 0.50, maximum = 0.81). A total of 559 predictors were used in the models. The five predictors most frequently used were gait speed (n = 47), age (n = 38), cognition (n = 27), frailty (n = 24), and gender (n = 22). No model can be recommended for implementation in practice. However, frailty models appear to be the most promising, because frailty components (e.g. gait speed) and frailty indexes demonstrated good to excellent predictive performance. However, the risk of study bias was high. Substantial improvements can be made in the methodology.

UI MeSH Term Description Entries
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000073496 Frailty A state of increased vulnerability to stressors, following declines in function and reserves across multiple physiologic systems, characterized by MUSCLE WEAKNESS; FATIGUE; slowed motor performance; low physical activity; and unintentional weight loss. Debility,Frailness,Frailty Syndrome,Debilities,Frailties
D000085542 Functional Status Ability regarding basic physical and cognitive activities such as walking or reaching, focusing attention, and communicating, as well as the routine activities of daily living, including eating, bathing, dressing, transferring, and toileting; and life situations such as school or play for children and, for adults, work outside the home or maintaining a household. (from https://www.ncvhs.hhs.gov/wp-content/uploads/2017/08/010617rp.pdf) Functional Dependence,Functional Independence,Independence, Functional,Status, Functional
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D016330 Frail Elderly Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. Elderly, Frail,Frail Older Adults,Functionally-Impaired Elderly,Frail Elders,Adult, Frail Older,Adults, Frail Older,Elder, Frail,Elderly, Functionally-Impaired,Elders, Frail,Frail Elder,Frail Older Adult,Functionally Impaired Elderly,Older Adult, Frail,Older Adults, Frail
D057187 Independent Living A housing and community arrangement that maximizes independence and self-determination. Aging in Place,Community Dwelling,Dwelling, Community,Dwellings, Community,Living, Independent

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