title: Effects of functional status changes before and during hospitalization on nursing home admission of older adults.
abstract: BACKGROUND
  Functional status changes before and during hospitalization may have important effects on outcomes in older adults, but these effects are not well understood. We determined the influence of functional status changes on the risk of nursing home (NH) admission after hospitalization.
  
  
  METHODS
  Subjects were 551 general medical patients > or = 70 years old (66% female; mean age = 80 years) admitted from home to a large Midwestern teaching hospital. Functional status change measures were based on patients' need for assistance in five personal activities of daily living (ADL) 2 weeks prior to hospital admission, the day of admission, and the day of discharge. Sociodemographic and clinical characteristics were included in multivariate models predicting NH admission.
  
  
  RESULTS
  Functional status change categories were: stable in function before and during hospitalization (45% of study patients); decline in function before and improvement during hospitalization (26%); stable before and decline during hospitalization (15%); decline before and no improvement during hospitalization (13%). In multivariate analyses, patients in the decline-no improvement group (odds ratio [OR] = 3.19; 95% confidence interval [CI] = 1.46-6.96) and patients in the stable-decline group (OR = 2.77; 95% CI = 1.29-5.96) were at greater risk for NH admission than patients in the stable-stable group. In a multivariate model that controlled for ADL function at hospital discharge, functional status change was no longer statistically significantly associated with NH admission.
  
  
  CONCLUSIONS
  Discharge function is a key risk factor for NH admission among hospitalized older adults. Because functional status changes before and during hospitalization are key determinants of discharge function, they provide important clues about the potential to modify that risk. Functional recovery during a hospital stay after prior functional decline, and prevention of in-hospital functional decline after prior functional stability, are important targets for clinical intervention to minimize the risk of NH admission.
authors.affiliation: Division of Geriatrics and Center on Aging, University of Connecticut Health Center, Farmington 06030-5215, USA. fortinsky@nso1.uchc.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Fortinsky
authors.forename: K E
authors.initials: KE
authors.lastname: Covinsky
authors.forename: R M
authors.initials: RM
authors.lastname: Palmer
authors.forename: C S
authors.initials: CS
authors.lastname: Landefeld
mesh_terms: D000244:Adenosine Diphosphate; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission
chemical_list: D000244:Adenosine Diphosphate