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Relationship between Functional Improvement and Cognition in Short-Stay Nursing Home Residents.
J Am Geriatr Soc. 2019 03; 67(3):553-557.JA

Abstract

OBJECTIVES

Improving function is an important outcome of postacute care in skilled nursing facilities (SNFs), but cognitive impairment can limit a resident's ability to improve during a postacute care stay. Our objective was to examine the association between residents' cognitive status on admission and change in self-care and mobility during a Medicare-covered SNF stay.

DESIGN

Retrospective analysis of Medicare beneficiaries who had a new SNF stay between January and June 2017.

SETTING

SNFs in the United States.

PARTICIPANTS

Newly admitted residents with Medicare-covered SNF stays between January and June 2017 (n = 246 395).

MEASUREMENTS

Residents' self-care and mobility at SNF admission and discharge were determined using items from Section GG (eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting, sit to stand, chair/bed transfer, and toilet transfer) of the Minimum Data Set. Residents were classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired, according to the Cognitive Function Scale. Multivariable regression models controlling for residents' demographic and clinical characteristics and SNF fixed effects were used to identify residents whose discharge scores for self-care and mobility were better or the same as expected according to their cognitive status on admission.

RESULTS

Residents who were cognitively impaired on admission had lower functional status on admission and were less likely to improve in self-care and mobility compared with residents who were cognitively intact. Approximately 63% of residents who were cognitively intact had discharge scores for self-care and mobility that were better or the same as expected compared with 45% of residents with severe cognitive impairment.

CONCLUSIONS

Cognitive impairment is associated with poorer self-care and mobility function among SNF residents. These findings have important implications for clinicians, who may need additional support when caring for residents with cognitive impairment to make the same improvements in functional status as residents who are cognitively intact. J Am Geriatr Soc 67:553-557, 2019.

Authors+Show Affiliations

Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas.Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island. Department of Veterans Affairs Medical Center, Providence, Rhode Island.

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

30548843

Citation

Loomer, Lacey, et al. "Relationship Between Functional Improvement and Cognition in Short-Stay Nursing Home Residents." Journal of the American Geriatrics Society, vol. 67, no. 3, 2019, pp. 553-557.
Loomer L, Downer B, Thomas KS. Relationship between Functional Improvement and Cognition in Short-Stay Nursing Home Residents. J Am Geriatr Soc. 2019;67(3):553-557.
Loomer, L., Downer, B., & Thomas, K. S. (2019). Relationship between Functional Improvement and Cognition in Short-Stay Nursing Home Residents. Journal of the American Geriatrics Society, 67(3), 553-557. https://doi.org/10.1111/jgs.15708
Loomer L, Downer B, Thomas KS. Relationship Between Functional Improvement and Cognition in Short-Stay Nursing Home Residents. J Am Geriatr Soc. 2019;67(3):553-557. PubMed PMID: 30548843.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between Functional Improvement and Cognition in Short-Stay Nursing Home Residents. AU - Loomer,Lacey, AU - Downer,Brian, AU - Thomas,Kali S, Y1 - 2018/12/13/ PY - 2018/08/28/received PY - 2018/10/30/revised PY - 2018/10/31/accepted PY - 2018/12/15/pubmed PY - 2020/3/19/medline PY - 2018/12/15/entrez KW - cognitive impairment KW - functional status KW - nursing homes KW - quality measures SP - 553 EP - 557 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 67 IS - 3 N2 - OBJECTIVES: Improving function is an important outcome of postacute care in skilled nursing facilities (SNFs), but cognitive impairment can limit a resident's ability to improve during a postacute care stay. Our objective was to examine the association between residents' cognitive status on admission and change in self-care and mobility during a Medicare-covered SNF stay. DESIGN: Retrospective analysis of Medicare beneficiaries who had a new SNF stay between January and June 2017. SETTING: SNFs in the United States. PARTICIPANTS: Newly admitted residents with Medicare-covered SNF stays between January and June 2017 (n = 246 395). MEASUREMENTS: Residents' self-care and mobility at SNF admission and discharge were determined using items from Section GG (eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting, sit to stand, chair/bed transfer, and toilet transfer) of the Minimum Data Set. Residents were classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired, according to the Cognitive Function Scale. Multivariable regression models controlling for residents' demographic and clinical characteristics and SNF fixed effects were used to identify residents whose discharge scores for self-care and mobility were better or the same as expected according to their cognitive status on admission. RESULTS: Residents who were cognitively impaired on admission had lower functional status on admission and were less likely to improve in self-care and mobility compared with residents who were cognitively intact. Approximately 63% of residents who were cognitively intact had discharge scores for self-care and mobility that were better or the same as expected compared with 45% of residents with severe cognitive impairment. CONCLUSIONS: Cognitive impairment is associated with poorer self-care and mobility function among SNF residents. These findings have important implications for clinicians, who may need additional support when caring for residents with cognitive impairment to make the same improvements in functional status as residents who are cognitively intact. J Am Geriatr Soc 67:553-557, 2019. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/30548843/Relationship_between_Functional_Improvement_and_Cognition_in_Short_Stay_Nursing_Home_Residents_ L2 - https://doi.org/10.1111/jgs.15708 DB - PRIME DP - Unbound Medicine ER -