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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access originally published online on February 6, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2009 64A(4):473-480; doi:10.1093/gerona/gln040
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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.

The Effects of Resident and Nursing Home Characteristics on Activities of Daily Living

Jye Wang1, Robert L. Kane2, Lynn E. Eberly3, Beth A. Virnig2 and Ling-Hui Chang4,*

1 Department of Health Care Administration, Chang Jung Christian University, Taiwan, Republic of China
2 Division of Health Policy and Management, University of Minnesota, Minneapolis
3 Division of Biostatistics, University of Minnesota, Minneapolis
4 Department of Occupational Therapy, Chung Shan Medical University, Taiwan, Republic of China

Address correspondence to Ling-Hui Chang, PhD, Department of Occupational Therapy, Chang Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Road, Taichung 402, Taiwan, ROC. Email: lchang56{at}csmu.edu.tw


  Abstract

Background: Existing studies on the relationships between impairments and activities of daily living (ADLs) in nursing home residents have serious limitations. This study examines the relationships among admission impairments, including pain, depression, incontinence, balance, and falls, and follow-up ADLs, as well as the effect of the nursing home on follow-up ADLs of extended-stay nursing home residents.

Methods: This longitudinal cohort study consisted of 4,942 extended-stay residents who were admitted into 377 Minnesota nursing homes during 2004. General linear mixed models were used for all analyses, with 14 resident-level and 8 facility-level control variables.

Results: Incontinence and balance function at admission were significantly associated with increases in ADL dependence at follow-up. Individual nursing homes had independent effects on all three ADL models. Similar findings were found after facility-level control variables were added.

Conclusions: Incontinence predicts subsequent ADL functional levels. The relationship between balance dysfunction and subsequent ADL dependence could be causal. Future studies of the causal relationships between impairments and ADL should examine the effectiveness of impairment interventions on ADL as well as these relationships in different subgroups of nursing home residents.

Keywords Nursing homes; Activities of daily living; Impairments; Incontinence; Falls

Received: March 27, 2008; Accepted: September 24, 2008

* This study was conducted at Division of Health Policy and Management, University of Minnesota in Twin Cities.

Decision Editor: Darryl Wieland, PhD, MPH


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