Saturday, 7 February 2015

Predicting institutionalization

Thorpe LU, Knox K, Jalbert R, Hyun-Ja Lim J, Nickel D, Hader WJ. Predictors of institutionalization for people with multiple sclerosis. Disabil Health J. 2014 . pii: S1936-6574(14)00185-X. 

BACKGROUND:Multiple Sclerosis (MS) is a chronic, progressive disease of the central nervous system with a high prevalence in Canada. While the disease course is highly variable, a significant portion of people with MS may spend more than 10 years living with severe disability, and many of those will eventually require full time institutional care. Despite the high personal and economic cost of this care, little is known about predictors of institutionalization.
OBJECTIVE:The objective of this study was to identify predictors of institutionalization.
METHODS: Longitudinal data from a university MS clinic database were extracted to explore nursing home placement over time of an urban subgroup. Analysis was performed with age of MS onset and sex, as well as baseline information obtained at the first MS clinic assessment: MS course, Kurtzke Expanded Disability Status Scale score, and functional system scores.
RESULTS:Older age of onset (p = .019) and higher baseline scores in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) were significant (p = .000, p = .000, p = .001, p = .000 respectively) predictors of nursing home placement.
CONCLUSIONS:Patients with older age of MS onset and those with baseline impairment in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) may be at higher risk for future institutionalization and should be assessed with particular care to determine potential avenues of support to minimize this.


ProfG has reported on the prognosis (future course) quite recently and this study confirms this view. As ever nothing is absolute and there MSers that it the bill but do better than predicted.

4 comments:

  1. Cant say I'm feeling too empowered by that bit of knowledge MD.
    Had any of those people been on a DMD?

    ReplyDelete
  2. This is why I sometimes hate this blog. I know you said it's not a one size fits all but with onset at age 50 with a brain stem lesion, reading this just fills me with despair. My EDSS is 2 and at last mri only had 3 lesions so I'm struggling to get anything stronger than Copaxone right now. How can I change that without relapsing or having adverse mri activity?

    ReplyDelete
    Replies
    1. Are three lesions, 3 lesions too many if you want NEDA.

      Delete
  3. Agree anon 1.39pm. Instead of keeping scaring the shite out of us, point to something we can do. I'm a patient not a medic. I'm convinced Team G has shares in Dignitas and leading brands of antidepressants. Yesterday was swallowing and today is care homes. Perhaps this is a ploy - fill us with fear and then announce that your work can stop this disease in its tracks. I waiting anxiously....

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.