Tags

Type your tag names separated by a space and hit enter

Activity of daily living trajectories surrounding acute hospitalization of long-stay nursing home residents.
J Am Geriatr Soc. 2013 Nov; 61(11):1909-18.JA

Abstract

OBJECTIVES

To explore patterns of change in nursing home (NH) residents' activities of daily living (ADLs), particularly surrounding acute hospital stays.

DESIGN

Longitudinal study using Medicare and Minimum Data Set (MDS) assessments.

SETTING

National sample of long-stay NH residents.

PARTICIPANTS

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.

MEASUREMENTS

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.

RESULTS

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.

CONCLUSION

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.

Authors+Show Affiliations

Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24219192

Citation

Kruse, Robin L., et al. "Activity of Daily Living Trajectories Surrounding Acute Hospitalization of Long-stay Nursing Home Residents." Journal of the American Geriatrics Society, vol. 61, no. 11, 2013, pp. 1909-18.
Kruse RL, Petroski GF, Mehr DR, et al. Activity of daily living trajectories surrounding acute hospitalization of long-stay nursing home residents. J Am Geriatr Soc. 2013;61(11):1909-18.
Kruse, R. L., Petroski, G. F., Mehr, D. R., Banaszak-Holl, J., & Intrator, O. (2013). Activity of daily living trajectories surrounding acute hospitalization of long-stay nursing home residents. Journal of the American Geriatrics Society, 61(11), 1909-18. https://doi.org/10.1111/jgs.12511
Kruse RL, et al. Activity of Daily Living Trajectories Surrounding Acute Hospitalization of Long-stay Nursing Home Residents. J Am Geriatr Soc. 2013;61(11):1909-18. PubMed PMID: 24219192.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Activity of daily living trajectories surrounding acute hospitalization of long-stay nursing home residents. AU - Kruse,Robin L, AU - Petroski,Gregory F, AU - Mehr,David R, AU - Banaszak-Holl,Jane, AU - Intrator,Orna, Y1 - 2013/10/28/ PY - 2013/11/14/entrez PY - 2013/11/14/pubmed PY - 2014/1/7/medline KW - Minimum Data Set KW - activities of daily living KW - hospitalization KW - nursing homes SP - 1909 EP - 18 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 61 IS - 11 N2 - OBJECTIVES: To explore patterns of change in nursing home (NH) residents' activities of daily living (ADLs), particularly surrounding acute hospital stays. DESIGN: Longitudinal study using Medicare and Minimum Data Set (MDS) assessments. SETTING: National sample of long-stay NH residents. PARTICIPANTS: 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. MEASUREMENTS: 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. RESULTS: 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. CONCLUSION: 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. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/24219192/Activity_of_daily_living_trajectories_surrounding_acute_hospitalization_of_long_stay_nursing_home_residents_ L2 - https://doi.org/10.1111/jgs.12511 DB - PRIME DP - Unbound Medicine ER -