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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access originally published online on August 6, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2009 64A(12):1296-1303; doi:10.1093/gerona/glp115
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Factors Associated With Recovery of Prehospital Function Among Older Persons Admitted to a Nursing Home With Disability After an Acute Hospitalization

Thomas M. Gill, Evelyne A. Gahbauer, Ling Han and Heather G. Allore

Department of Internal Medicine, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, New Haven, Connecticut

Address correspondence to Thomas M. Gill, MD, Department of Internal Medicine, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504. Email: thomas.gill{at}yale.edu


  Abstract

Background: The objective of this study was to identify the factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization.

Methods: The analytic sample included 292 participants of an ongoing cohort study who had one or more admissions to a nursing home with disability after an acute hospitalization during nearly 10 years of follow-up, yielding a total of 364 "index" nursing home admissions. Information on nursing home admissions, hospitalizations, and disability in essential activities of daily living was ascertained during monthly telephone interviews. Data on potential predictors of functional recovery were collected during comprehensive assessments, which were completed every 18 months for 90 months. Participants were considered to have recovered if they were discharged home within 6 months of their nursing home admission at (or above) their prehospital level of function.

Results: Recovery of prehospital function was observed for 115 (31.6%) of the 364 index nursing home admissions. In the multivariate analysis, the strongest associations were observed for the best category of performance, relative to the poorest category, for gross motor coordination (hazard ratio [HR] 13.5, 95% confidence interval [CI] 4.02–45.0) and manual dexterity (HR 10.0, 95% CI 2.94–34.3). Only two other factors were independently associated with recovery of prehospital function: not cognitively impaired (HR 3.0, 95% CI 1.46–6.14) and no significant weight loss (HR 1.96, 95% CI 1.06–3.63).

Conclusions: In the setting of an acute hospitalization leading to a nursing home admission with disability, the likelihood of recovering prehospital function is low. The factors associated with recovery include faster performance on tests of gross motor coordination and manual dexterity and the absence of cognitive impairment and significant weight loss.

Keywords Disability evaluation; Nursing homes; Cohort studies

Received: April 23, 2009; Accepted: July 10, 2009

Decision Editor: Luigi Ferrucci, MD, PhD


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