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Effects of cognitive performance on change in physical function in long-stay nursing home residents.
J Gerontol A Biol Sci Med Sci. 2002 Dec; 57(12):M778-84.JG

Abstract

BACKGROUND

Determining the nature and rate of change in physical function among long-stay nursing home (NH) residents classified by cognitive performance is needed to inform judgments about prognosis and design of clinical trials to minimize functional decline.

METHODS

The study consisted of a longitudinal analysis using random coefficients models of 71,388 noncomatose residents aged 65 and older admitted in one of five states participating in the Health Care Financing Administration-sponsored National Case Mix and Quality Demonstration Project who stayed in the nursing home 1 year or longer. Linear effects of cognitive impairment on admission and over time on the trajectory of dependence in activities of daily living (ADLs) were estimated, adjusting for demographic status upon admission. Interaction terms were used to determine if subgroups of residents at the same cognitive level were at risk for a steeper than average rate of decline. Measures were derived from the NH Minimum Data Set (MDS+) ratings of each domain. Cognition was measured using the MDS-Cognitive Performance Scale. Physical function was determined by summing ADL dependence ratings of bathing, dressing, grooming, toileting, and eating (range 0 to 20). Demographics included age, gender, race, and marital status.

RESULTS

On average, ADL dependence worsened 0.84 points per year among these long-stay residents. Only cognition and marital status had clinically significant effects on ADL dependence. Married residents exhibited more ADL dependence than unmarried residents. Severity of cognitive impairment on admission and over time influenced severity of ADL dependence but not rate of decline. No interaction terms were clinically significant.

CONCLUSIONS

Clinicians seeking to identify factors that accelerate ADL decline in long-stay NH residents must examine explanatory variables other than cognitive impairment and demographics.

Authors+Show Affiliations

School of Nursing, Duke University, Durham, North Carolina 27710, USA. mccon002@mc.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12456736

Citation

McConnell, Eleanor S., et al. "Effects of Cognitive Performance On Change in Physical Function in Long-stay Nursing Home Residents." The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, vol. 57, no. 12, 2002, pp. M778-84.
McConnell ES, Pieper CF, Sloane RJ, et al. Effects of cognitive performance on change in physical function in long-stay nursing home residents. J Gerontol A Biol Sci Med Sci. 2002;57(12):M778-84.
McConnell, E. S., Pieper, C. F., Sloane, R. J., & Branch, L. G. (2002). Effects of cognitive performance on change in physical function in long-stay nursing home residents. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 57(12), M778-84.
McConnell ES, et al. Effects of Cognitive Performance On Change in Physical Function in Long-stay Nursing Home Residents. J Gerontol A Biol Sci Med Sci. 2002;57(12):M778-84. PubMed PMID: 12456736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of cognitive performance on change in physical function in long-stay nursing home residents. AU - McConnell,Eleanor S, AU - Pieper,Carl F, AU - Sloane,Richard J, AU - Branch,Laurence G, PY - 2002/11/29/pubmed PY - 2003/2/7/medline PY - 2002/11/29/entrez SP - M778 EP - 84 JF - The journals of gerontology. Series A, Biological sciences and medical sciences JO - J. Gerontol. A Biol. Sci. Med. Sci. VL - 57 IS - 12 N2 - BACKGROUND: Determining the nature and rate of change in physical function among long-stay nursing home (NH) residents classified by cognitive performance is needed to inform judgments about prognosis and design of clinical trials to minimize functional decline. METHODS: The study consisted of a longitudinal analysis using random coefficients models of 71,388 noncomatose residents aged 65 and older admitted in one of five states participating in the Health Care Financing Administration-sponsored National Case Mix and Quality Demonstration Project who stayed in the nursing home 1 year or longer. Linear effects of cognitive impairment on admission and over time on the trajectory of dependence in activities of daily living (ADLs) were estimated, adjusting for demographic status upon admission. Interaction terms were used to determine if subgroups of residents at the same cognitive level were at risk for a steeper than average rate of decline. Measures were derived from the NH Minimum Data Set (MDS+) ratings of each domain. Cognition was measured using the MDS-Cognitive Performance Scale. Physical function was determined by summing ADL dependence ratings of bathing, dressing, grooming, toileting, and eating (range 0 to 20). Demographics included age, gender, race, and marital status. RESULTS: On average, ADL dependence worsened 0.84 points per year among these long-stay residents. Only cognition and marital status had clinically significant effects on ADL dependence. Married residents exhibited more ADL dependence than unmarried residents. Severity of cognitive impairment on admission and over time influenced severity of ADL dependence but not rate of decline. No interaction terms were clinically significant. CONCLUSIONS: Clinicians seeking to identify factors that accelerate ADL decline in long-stay NH residents must examine explanatory variables other than cognitive impairment and demographics. SN - 1079-5006 UR - https://www.unboundmedicine.com/medline/citation/12456736/Effects_of_cognitive_performance_on_change_in_physical_function_in_long_stay_nursing_home_residents_ L2 - https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/57.12.m778 DB - PRIME DP - Unbound Medicine ER -