Activity of Daily Living Trajectories Surrounding Acute Hospitalization of Long-Stay Nursing Home Residents
Article first published online: 28 OCT 2013
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 61, Issue 11, pages 1909–1918, November 2013
How to Cite
J Am Geriatr Soc 61:1909–1918, 2013.
- Issue published online: 12 NOV 2013
- Article first published online: 28 OCT 2013
- National Institute on Aging of the National Institutes of Health. Grant Number: R01AG028476
- nursing homes;
- activities of daily living;
- Minimum Data Set
To explore patterns of change in nursing home (NH) residents’ activities of daily living (ADLs), particularly surrounding acute hospital stays.
Longitudinal study using Medicare and Minimum Data Set (MDS) assessments.
National sample of long-stay NH residents.
NH residents who were hospitalized for the seven most-common inpatient diagnoses (N = 40,128). Each hospital admission was at least 90 days after any prior hospitalization and had at least two preceding MDS assessments.
The MDS ADL long-form score, a simple sum of seven self-care variables coded from 0 (independent) to 4 (totally dependent) was used to indicate resident ADL function. Scores ranged from 0 to 28, with higher scores indicating greater impairment. A linear mixed model describing ADL trajectories was jointly estimated with time-to-event models for mortality and hospital readmission.
Before hospitalization, the most common trajectory was stable (53.7%), with 27.5% of residents worsening and 18.8% improving. ADL function after hospital discharge was most often characterized as stable (43.1%) or worsening (39.2%). Mortality (20.3%) was higher for those with worsening prehospital ADL function (28.9%) than for those with stable (19.1%) or improving (11.3%) trajectories. Hospital diagnosis was associated with amount of ADL worsening and rate of subsequent ADL change. Most residents with the best initial function continued to worsen after hospital discharge. Cognitive impairment was associated with poorer ADL function and accelerated worsening of ADLs.
For many long-stay NH residents, substantial and sustained ADL worsening accompanies acute hospitalization, so acute hospitalization presents an opportunity to revisit care goals; the results of the current study can help inform decision-making.