Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility Admission

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• 作者：Bianca M. Buurman ; RN ; PhD^a ; ^b ; ^{b.m.vanes@amc.nl" class="auth_mail" title="E-mail the corresponding author} ; Ling Han ; MD ; PhD^a ; Terrence E. Murphy ; PhD^a ; Evelyne A. Gahbauer ; MD ; MPH^a ; Linda Leo-Summers ; MPH^a ; Heather G. Allore ; PhD^a ; Thomas M. Gill ; MD^a
• 关键词：Skilled nursing facility ; disability ; post-acute care ; functional decline ; hospitalization ; readmission ; mortality ; elderly
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 March 2016
• 年：2016
• 卷：17
• 期：3
• 页码：225-231
• 全文大小：749 K

文摘

To identify distinct sets of disability trajectories in the year before and after a Medicare qualifying skilled nursing facility (Q-SNF) admission, evaluate the associations between the pre–and post–Q-SNF disability trajectories, and determine short-term outcomes (readmission, mortality).

Design, setting, and participants

Prospective cohort study including 754 community-dwelling older persons, 70+ years, and initially nondisabled in their basic activities of daily living. The analytic sample included 394 persons, with a first hospitalization followed by a Q-SNF admission between 1998 and 2012.

Main outcomes and measures

Disability in the year before and after a Q-SNF admission using 13 basic, instrumental, and mobility activities. Secondary outcomes included 30-day readmission and 12-month mortality.

Results

The mean (SD) age of the sample was 84.9 (5.5) years. We identified 3 disability trajectories in the year before a Q-SNF admission: minimal disability (37.3% of participants), mild disability (44.6%), and moderate disability (18.2%). In the year after a Q-SNF admission, all participants started with moderate to severe disability scores. Three disability trajectories were identified: substantial improvement (26.0% of participants), minimal improvement (36.5%), and no improvement (37.5%). Among participants with minimal disability pre–Q-SNF, 52% demonstrated substantial improvement; the other 48% demonstrated minimal improvement (32%) or no improvement (16%) and remained moderately to severely disabled in the year post–Q-SNF. Among participants with mild disability pre–Q-SNF, 5% showed substantial improvement, whereas 95% showed little to no improvement. Of participants with moderate disability pre–Q-SNF, 15% remained moderately disabled showing little improvement, whereas 85% showed no improvement. Participants who transitioned from minimal disability pre–Q-SNF to no improvement post–Q-SNF had the highest rates of 30-day readmission and 12-month mortality (rate/100 person-days 1.3 [95% CI 0.6–2.8] and 0.3 [95% CI 0.15–0.45], respectively).

Conclusions

Among older persons, distinct disability trajectories were observed in the year before and after a Q-SNF admission. The likelihood of improvement in disability was greatly constrained by the pre–Q-SNF disability trajectory. Most older persons remained moderately to severely disabled in the year following a Q-SNF admission.