• Daisy J A Janssen, Jos M G A Schols, Emiel F M Wouters, and Martijn A Spruit.
• Program Development Center, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands; Center of Expertise for Palliative Care, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands. Electronic address: daisyjanssen@ciro-horn.nl.
• J Am Med Dir Assoc. 2014 Feb 1;15(2):127-32.

ObjectivesCare 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.DesignLongitudinal observational study.ParticipantsClinically stable patients with advanced COPD (n = 105), CHF (n = 80), or CRF (n = 80) were recruited at outpatient clinics of 7 Dutch hospitals.MeasurementsPatients 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.ResultsCOPD 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.ConclusionsCare 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.Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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