Effect of Case Management after Functional Evaluation in the Annual Elderly Health Examination
Bibliographic record
Abstract
Objectives: The items of annual elderly health examination from Taipei city government are mainly disease oriented at present. However, screening for frail elderly and preventing their functional decline are also very important. We tried to increase function evaluation in the elderly annual health examination and use case management method to improve the function of examinees thereafter. Methods: This is a quasi-experimental controlled trial. Four hundred and four adults aged 70 and older who joined in the 2013 annual elderly health examination at Taipei city hospital Yangming branch and Canadian Study of Health and Aging Clinical Frailty Scale (CSHA- CFS) Chinese In-Person Interview Version scored 3-6 were enrolled. One hundred and thirty two participants who agreed to receive functional examination joined in the experimental group. Interventions: Experiment group received CSHA- CFS, Fried Frailty Index(FFI), timed up and go test(TUG), Short-form Physical Performance Battery (SPPB) examination, exercise instruction and nutrition education at 0, 3rd and 12th month and routine annual elderly health examination at 0 and 12th month. Case manager reminded the experimental group to keep exercise and nutrition supplement by telephone interview at 6th and 9th month. Control group receive CSHA- CFS and routine annual elderly health examination at 0 and 12th month. Both groups received telephone interview to collect adverse event data at 3rd, 6th, 9th and 12th month. Results: The baseline characteristics including gender, age, CSHACFA, difficult in walking 800 meters, difficult in climbing 10 stairs, number of comorbidity... were similar for the two groups.112 (84.5%) persons of experimental group and 267 (98.2%) persons of control group completed the study. CSHA- CFS of the experimental group were more likely to improve (OR=9.50, 95% CI=4.62-19.56) and less likely to deteriorate (OR=0.04, 95% CI=0.01-0.31), one year after intervention respectively. Within experimental group, FFI improvement percentage was greater than deterioration percentage (46.4% vs. 2.4%, p＜0.0001), five meters walk speed increased from 1.0±0.2 m/sec to 1.2±0.2 m/ sec (p＜0.0001), grip strength increased from 22.3±7.1kg to 24.8±6.7 kg (p＜0.0001), SPPB increased from 10.0±1.6 to 11.0±1.2 (p＜0.0001), TUG decreased from 10.9±2.9 second to 9.5±2.1 second (p＜0.0001). However, there was no statistical difference of composite endpoint including hospitalization, emergency department visit and falls between two groups though the incidence of composite endpoint was higher in the control group. Conclusions: Case management after functional evaluation in the annual elderly health examination may improve function for adults above 70 years old. We suggests to add FFI and TUG in the annual elderly examination.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".