Sequence of Disabilities
Network Analysis
Presented by Farrokh Alemi, Ph.D.
Research conducted by Cari Levy M.D., Manaf Zargoush Ph.D., Raya E.
Kheirbek M.D., Allison E. Williams Ph.D., Arthur R. Williams Ph.D., Janusz
Wojtusiak Ph.D., Bryce Sutton Ph.D., Etienne Pracht Ph.D., Bruce Citron Ph.D.,
Lisa Argyros and Phan Giang Ph.D.
We Agree
Causal Network Models:
Association, Sequence,
Counterfactual, Mechanism
Causal Network Models:
Association, Sequence,
Counterfactual, Mechanism
Sequence of disabilities has
been the focus of cultural
and scientific inquiries
“His acts being seven ages …
The sixth age shifts
into the lean and slippered pantaloon,
with spectacles on nose and pouch on side;
his youthful hose, well saved, a world too wide
for his shrunk shank; and his big manly voice,
turning again toward childish treble, pipes
and whistles in his sound. Last scene of all,
that ends this strange eventful history,
is second childishness and mere oblivion,
sans teeth, sans eyes, sans taste, sans everything.”
Shakespeare: As You Like It: Act 2, Scene 7, Page 6
5
6
7
1963
50
Bathing
Walking
Dressing
Transfer
Toileting
Katz, Ford, Moskowitz, Jackson, & Jaffe
Feeding
1997
Bathing
Walking
Dressing
Transfer
Toileting
Dunlop, Hughes, & Manheim
Feeding
1998
Bathing
Walking
Dressing
Transfer
Toileting
Spector & Fleishman
Feeding
1998
Bathing
Walking
Dressing
Transfer
Toileting
Ferrucci, Guralnik, Cecchi et al
Feeding
We excluded from this list cutting toenails, shopping, use of steps, heavy housework, cooking hot meal, moving around outside, washing arms/face and
light housework which were not studied across studies. Bathing includes showering or full wash and not simply face wash.
2001
Bathing
Walking
Dressing
Transfer
Toileting
Jagger, Arthur, Spiers, Clarke
Transferring refers to transfer from bed and not simply transfer from chair or toilet
Feeding
2012
Bathing
Walking
Dressing
Transfer
Toileting
Kingston, Collerton, Davies et al.
Feeding
Transferring refers to transfer from bed and not simply transfer from chair or toilet. Toileting includes transfer from toilet.
Gill & Kurland 2003
A Multiple Path Network
Model Is Needed
296,051
Residents
Admissions
1,820,714
Assessments
79.88% White, 96.34% Men, 74.36 years (SD=11.44) Old at 1st Assessment
Too Much
All Data
25 Combinations
84% of All Cases
B=Bathe, W=Walk, G=Groom, D=Dress, T=Toilet
B=Bathe, W=Walk, G=Groom, D=Dress, T=Toilet, L=Bowel Continence, S=Transfer, U=Urinary Continence and F=Feeding disabilities
Trimmed Mean Days to Partial Recovery of One Disability
Insurance
Still Too Confusing
Statistical Summary
Learn New Network Model
Relationship of 9 Disabilities
Nodes Are Connected Based
on Associations
Direction is Set Based on
Independence Structure
Algorithms for Learning
Network Models
Cross Section Analysis
Longitudinal Analysis
Algorithms for Dynamic
Modeling: Confusing
Network Model
Do as Humans Do
Learn Network Model
Cross Section Analysis
Longitudinal Analysis
Subject to Longitudinal
Constraints
Probabilistic Contrast
Do as Humans Do
Numbers show the correlation between two disabilities. Dashed red arrows show the maximum likelihood path.
Many Pathways from Start to End
Numbers show the correlation between two disabilities. Dashed red arrows show the maximum likelihood path.
Analytical Progress
Use Longitudinal Constraints
Clinical Relevance
Experience of Majority
Policy Implications
Don’t Give Up at 100 Days