One-year stability of care dependency in patients with advanced chronic organ failure

J Am Med Dir Assoc. 2014 Feb;15(2):127-32. doi: 10.1016/j.jamda.2013.10.002. Epub 2013 Dec 4.


Objectives: Care dependency is a determinant of quality of life and survival among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), or chronic renal failure (CRF). The objectives of this study were to explore the profiles of care dependency in patients with advanced COPD, CHF, or CRF; to study the changes in care dependency during 1-year follow-up; and to study whether 1-year changes in care dependency are comparable between patients with advanced COPD, CHF, or CRF.

Design: Longitudinal observational study.

Participants: Clinically stable patients with advanced COPD (n = 105), CHF (n = 80), or CRF (n = 80) were recruited at outpatient clinics of 7 Dutch hospitals.

Measurements: Patients were visited at home at baseline, and at 4, 8, and 12 months to assess demographic and clinical characteristics, comorbidities (Charlson comorbidity index), care dependency (Care Dependency Scale), mobility, health status, and symptom burden.

Results: COPD and CHF patients reported a higher baseline level of care dependency than patients with CRF. Care dependency differed between patients with COPD, CHF, or CRF in the items 'getting (un)dressed,' 'hygiene,' 'contact with others,' and 'sense of rules/values.' One-year follow-up was completed by 206 patients (77.7%). Patients with COPD were more likely to experience an increase in care dependency. An increase in care dependency was associated with higher age, higher number of hospital admissions, decrease in health status, and worsening of Charlson comorbidity index score.

Conclusions: Care dependency profiles differ between patients with COPD, CHF, or CRF. Patients with advanced COPD are at risk for a 1-year increase in care dependency. Regular assessment of care dependency and addressing care dependency in palliative care programs for patients with advanced COPD, CHF, or CRF are needed.

Keywords: Chronic obstructive pulmonary disease; chronic heart failure; dialysis; functional status; palliative care.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Age Factors
  • Aged
  • Comorbidity
  • Disability Evaluation*
  • Female
  • Health Services Needs and Demand*
  • Health Status
  • Heart Failure / epidemiology*
  • Hospitalization / statistics & numerical data
  • Humans
  • Kidney Failure, Chronic / epidemiology*
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Netherlands
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Sampling Studies
  • Severity of Illness Index

Associated data

  • NTR/NTR1552