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Exp Gerontol. 2017 Oct 15;97:73-79. doi: 10.1016/j.exger.2017.08.004. Epub 2017 Aug 4.

The subsequent course of disability in older persons discharged to a skilled nursing facility after an acute hospitalization.

Author information

1
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. Electronic address: Zuyun.liu@yale.edu.
2
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

Abstract

OBJECTIVES:

To evaluate the association between the type of acute hospitalization and subsequent course of disability in older persons discharged to a skilled nursing facility (SNF).

DESIGN:

Longitudinal study of 754 community-living persons aged 70 or older.

PARTICIPANTS:

The analytical sample included 365 participants who had one or more admissions to a SNF after an acute hospitalization (n=520 index admissions).

MEASUREMENTS:

Information on hospitalizations, SNF admissions, and disability was ascertained over 15years. The primary and secondary outcomes were disability burden and recovery of pre-hospital function, respectively, assessed monthly over a 6-month period. Index admissions were classified into four mutually exclusive groups based on the type of hospitalization: elective major surgery, non-elective major surgery, critical illness, and other.

RESULTS:

Disability worsened considerably after hospitalization for each of the four groups. Relative to elective major surgery, the disability burden over 6months was significantly greater for non-elective major surgery, critical illness, and other hospitalizations, with adjusted rate ratios (RRs) of 1.37 (95% CI 1.19 to 1.59), 1.37 (95% CI 1.19 to 1.58), and 1.29 (95% CI 1.14 to 1.47), respectively. Overall, recovery to pre-hospital function was observed in only 132 (25.4%) admissions. Relative to elective major surgery, the likelihood of recovering pre-hospital function was considerably lower for each of the three other groups. The results were consistent for basic, instrumental and mobility activities.

CONCLUSION:

Among older persons discharged to a SNF after an acute hospitalization, the functional course over 6months was generally poor, with recovery to pre-hospital function observed in only one out of every four cases. Relative to elective major surgery, functional outcomes were worse for non-elective major surgery, critical illness, and other hospitalizations.

KEYWORDS:

Disability burden; Functional recovery; Hospitalization; Older; Skilled nursing facility

PMID:
28782593
PMCID:
PMC5793887
DOI:
10.1016/j.exger.2017.08.004
[Indexed for MEDLINE]
Free PMC Article

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