TILE-12 index: an interpretable instrument for identifying older adults at risk for transitions in living environment within the next 12-months

ABSTRACT

Few evidence-based tools exist to support identification of older community dwelling adults at risk for unwanted transitions in living environment leading to missed opportunities to modify care plans to support aging-in-place and/or establish end-of-life care goals. An interpretable and actionable tool for assessing a person’s risk of experiencing a transition is introduced. Logistic regression analysis of 14,772 transition opportunities (i.e. 12-month periods) for 4,431 respondents to the National Health and Aging Trends Study (NHATS) rounds 1–7. Results were visualized in a nomogram. Unmarried males of increasing age with chronic disease, greater functional dependence, overnight hospitalizations, not living in a single-family home, and limited social network, have elevated risk of experiencing a transition in living environment in a 12-month period. Homecare nurses are uniquely qualified to identify social determinants of health and can use this evidence-based tool to identify individuals who may benefit from transitional care assistance.

KEYWORDS:

• Transitional care
• decision support systems
• clinical
• advance care planning
• social determinants of health
• older adults

Acknowledgments

This manuscript is based on publicly available data in compliance with the use of sensitive data and in concordance with the Sensitive Data Supplemental Agreement and Data Use Agreements. The authors have no conflicts of interest to report. The National Health and Aging Trends Study (NHATS) is sponsored by the National Institute on Aging (grant number NIA U01AG32947) and was conducted by the Johns Hopkins University. Dr. Sullivan is funded in part, by the National Institutes of Aging under Award Number R03 AG067159. The authors are also grateful for the support of Dr. Chin-Shang Li, of the University at Buffalo School of Nursing Center for Nursing Research, for his help and guidance during preparation of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Study concept and design: Roma, Sullivan, Casucci; Acquisition, analysis, and interpretation of data: Roma, Sullivan, Casucci; Drafting and revision of manuscript: Roma, Sullivan, Casucci.

Additional information

Funding

This work was supported by the National Institutes on Aging [R03 AG067159].