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Functional Trajectories in Older Persons Admitted to a Nursing Home with Disability After an Acute Hospitalization
Author(s) -
Gill Thomas M.,
Gahbauer Evelyne A.,
Han Ling,
Allore Heather G.
Publication year - 2009
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2008.02107.x
Subject(s) - medicine , activities of daily living , interquartile range , nursing homes , bathing , cohort , prospective cohort study , physical therapy , gerontology , nursing , surgery , pathology
OBJECTIVES: To characterize the functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization. DESIGN: Prospective cohort study of 754 community‐living persons aged 70 and older who were initially nondisabled in four essential activities of daily living (ADLs). SETTING: Greater New Haven, Connecticut. PARTICIPANTS: The analytical sample included 296 participants who were newly admitted to a nursing home with disability after an acute hospitalization. MEASUREMENTS: Information on nursing home admissions, hospitalizations, and disability in essential ADLs was ascertained during monthly telephone interviews for up to 9 years. Disability was defined as the need for personal assistance in bathing, dressing, walking inside one's home, or transferring from a chair. RESULTS: The median time to the first nursing home admission with disability after an acute hospitalization was 46 months (interquartile range 27.5–75.5), and the mean number±standard deviation of ADLs that participants were disabled in upon admission was 3.0±1.2. In the month preceding hospitalization, 189 (63.9%) participants had no disability. The most common functional trajectory was discharged home with disability (46.3%), followed by continuous disability in the nursing home (27.4%), discharged home without disability (21.6%), and noncontinuous disability in the nursing home (4.4%). Only 96 (32.4%) participants returned home at (or above) their premorbid level of function. CONCLUSION: The functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization are generally poor. Additional research is needed to identify the factors responsible for these poor outcomes.