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Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation.
Clin J Am Soc Nephrol. 2016 12 07; 11(12):2218-2224.CJ

Abstract

BACKGROUND AND OBJECTIVES

The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We identified 40,615 Medicare beneficiaries ≥65 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as ≥100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of nondisease-specific problems (≤1, 2, 3, and 4-6) with 6-month mortality, LTC, and functional impairment were examined.

RESULTS

Overall, 39.2% of patients who received SNF care after dialysis initiation died within 6 months. Compared with those with ≤1 nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4-6 nondisease-specific problems, respectively. Among those who survived, 37.1% required LTC; of those remaining who did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among those who survived 6 months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems.

CONCLUSIONS

Identifying nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation.

Authors+Show Affiliations

Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta Veterans Affairs Medical Center (VAMC), Decatur, Georgia; cbbowli@emory.edu. Division of General Medicine and Geriatrics, Department of Medicine.Division of General Medicine and Geriatrics, Department of Medicine. Division of Renal Medicine, Department of Medicine. Department of Epidemiology.Department of Veterans Affairs, Geriatric Research, Education and Clinical Center and. Renal Section, Durham VAMC, Durham, North Carolina; and. Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta Veterans Affairs Medical Center (VAMC), Decatur, Georgia. Division of General Medicine and Geriatrics, Department of Medicine.Rehabilitation/Quality of Life Special Studies Center, United States Renal Data System, and. Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.Rehabilitation/Quality of Life Special Studies Center, United States Renal Data System, and.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

27733436

Citation

Bowling, C Barrett, et al. "Association of Nondisease-Specific Problems With Mortality, Long-Term Care, and Functional Impairment Among Older Adults Who Require Skilled Nursing Care After Dialysis Initiation." Clinical Journal of the American Society of Nephrology : CJASN, vol. 11, no. 12, 2016, pp. 2218-2224.
Bowling CB, Plantinga L, Hall RK, et al. Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation. Clin J Am Soc Nephrol. 2016;11(12):2218-2224.
Bowling, C. B., Plantinga, L., Hall, R. K., Mirk, A., Zhang, R., & Kutner, N. (2016). Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation. Clinical Journal of the American Society of Nephrology : CJASN, 11(12), 2218-2224.
Bowling CB, et al. Association of Nondisease-Specific Problems With Mortality, Long-Term Care, and Functional Impairment Among Older Adults Who Require Skilled Nursing Care After Dialysis Initiation. Clin J Am Soc Nephrol. 2016 12 7;11(12):2218-2224. PubMed PMID: 27733436.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation. AU - Bowling,C Barrett, AU - Plantinga,Laura, AU - Hall,Rasheeda K, AU - Mirk,Anna, AU - Zhang,Rebecca, AU - Kutner,Nancy, Y1 - 2016/10/12/ PY - 2016/02/04/received PY - 2016/08/22/accepted PY - 2016/10/14/pubmed PY - 2017/12/2/medline PY - 2016/10/14/entrez KW - Accidental Falls KW - Activities of Daily Living KW - Cognition Disorders KW - Humans KW - Long-Term Care KW - Medicare KW - Patient Discharge KW - Polypharmacy KW - Registries KW - Skilled Nursing Facilities KW - United States KW - depression KW - dialysis KW - geriatric nephrology KW - hospitalization KW - mortality KW - renal dialysis SP - 2218 EP - 2224 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 11 IS - 12 N2 - BACKGROUND AND OBJECTIVES: The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We identified 40,615 Medicare beneficiaries ≥65 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as ≥100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of nondisease-specific problems (≤1, 2, 3, and 4-6) with 6-month mortality, LTC, and functional impairment were examined. RESULTS: Overall, 39.2% of patients who received SNF care after dialysis initiation died within 6 months. Compared with those with ≤1 nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4-6 nondisease-specific problems, respectively. Among those who survived, 37.1% required LTC; of those remaining who did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among those who survived 6 months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems. CONCLUSIONS: Identifying nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/27733436/Association_of_Nondisease_Specific_Problems_with_Mortality_Long_Term_Care_and_Functional_Impairment_among_Older_Adults_Who_Require_Skilled_Nursing_Care_after_Dialysis_Initiation_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=27733436 DB - PRIME DP - Unbound Medicine ER -