Presented by Farrokh Alemi, Ph.D.

Sequence of DisabilitiesNetwork Analysis

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.

I Know, Y

ou Know We All Know

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 shiftsinto the lean and slippered pantaloon,with spectacles on nose and pouch on side;his youthful hose, well saved, a world too widefor his shrunk shank; and his big manly voice,turning again toward childish treble, pipesand 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

67

5

Katz, Ford, Moskowitz, Jackson, & Jaffe

1963

Bathing

Walking

Dressing

Transfer

Toileting

Feeding

50

Dunlop, Hughes, & Manheim

1997

Bathing

Walking

Dressing

Transfer

Toileting

Feeding

Spector & Fleishman

1998

Bathing

Walking

Dressing

Transfer

Toileting

Feeding

Ferrucci, Guralnik, Cecchi et al

1998

Bathing

Walking

Dressing

Transfer

Toileting

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.

Jagger, Arthur, Spiers, Clarke

2001

Bathing

Walking

Dressing

Transfer

Toileting

Feeding

Transferring refers to transfer from bed and not simply transfer from chair or toilet

Kingston, Collerton, Davies et al.

2012

Bathing

Walking

Dressing

Transfer

Toileting

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

Admissions29

6,05

1 Re

side

nt s

1,820,714 Assessments

79.88% White, 96.34% Men, 74.36 years (SD=11.44) Old at 1st Assessment

25 Combinations84% of All CasesAl

l Dat

a

Too

Muc

h

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 ConfusingStatistical Summary

Learn New Network ModelRelationship of 9 Disabilities

Nodes Are Connected Based on Associations

Direction is Set Based on Independence Structure

Cross Section AnalysisLongitudinal Analysis

Algorithms for Learning Network Models

Algorithms for Dynamic Modeling: Confusing

Network Model

Cross Section AnalysisLongitudinal Analysis

Learn Network Model

Subject to Longitudinal Constraints

Do as Humans Do

Probabilistic ContrastDo as Humans Do

Numbers show the correlation between two disabilities. Dashed red arrows show the maximum likelihood path.

Numbers show the correlation between two disabilities. Dashed red arrows show the maximum likelihood path.

Same

Sam

e

Many Pathways from Start to End

Analytical ProgressUse Longitudinal Constraints

Clinical RelevanceExperience of Majority

Policy ImplicationsDon’t Give Up at 100 Days