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Am J Phys Med Rehabil. 2017 Jul;96(7):464-472. doi: 10.1097/PHM.0000000000000653.

The Association Between Activity Limitation Stages and Admission to Facilities Providing Long-term Care Among Older Medicare Beneficiaries.

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From the Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics (JEK, DX, SH, LN, QP, PLK), and Geriatric Psychiatry Section of the Department of Psychiatry (JES), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; VISN 4 Mental Illness Research Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (JES); Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, Pennsylvania (SH); Department of Geriatrics and Gerontology at UCLA, Los Angeles, California (DS); VA Greater Los Angeles Healthcare System (GLAHS) Geriatric Research, Education and Clinical Center (GRECC), Los Angeles, California (DS); RAND Health, Santa Monica, California (DS); and Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania (HRB).



This study aimed to examine whether activity limitation stages are associated with admission to facilities providing long-term care (LTC).


Cohort study using Medicare Current Beneficiary Survey data from the 2005-2009 entry panels. A total of 14,580 community-dwelling Medicare beneficiaries 65 years or older were included. Proportional subhazard models examined associations between activity limitation stages and time to first LTC admission, adjusting for baseline sociodemographics and health conditions.


The weighted annual rate of LTC admission was 1.1%. In the adjusted model, compared to activity of daily living (ADL) stage 0, the hazard ratios (95% confidence intervals [CIs]) were 2.0 (1.5-2.7), 3.9 (2.9-5.4), 3.6 (2.5-5.3), and 4.7 (2.5-9.0) for ADL stage I (mild limitation), ADL stage II (moderate limitation), ADL stage III (severe limitation), and ADL stage IV (complete limitation), respectively. Compared to instrumental ADL (IADL) stage 0, the hazard ratios, and 95% CIs for IADL stages I to IV were 2.0 (1.4-2.7), 3.7 (2.6-5.4), 4.6 (3.3-6.5), and 7.6 (4.6-12.3), respectively.


Activity limitation stages are strongly associated with future admission to LTC and may therefore be useful in identifying specific supportive care needs among vulnerable older community-dwelling adults, which may reduce or the delay need for admission to LTC.

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