title: Rates of acute care admissions for frail older people living with met versus unmet activity of daily living needs.
abstract: OBJECTIVE
  To determine whether older people who do not have help for their activity of daily living (ADL) disabilities are at higher risk for acute care admissions and whether entry into a program that provides for these needs decreases this risk.
  
  
  METHODS
  A longitudinal cohort study.
  
  
  METHODS
  Thirteen nationwide sites for the Program of All-inclusive Care for the Elderly (PACE). PACE provides comprehensive medical and long-term care to community-living older adults.
  
  
  METHODS
  Two thousand nine hundred forty-three PACE enrollees with one or more ADL dependencies.
  
  
  METHODS
  Unmet needs were defined as the absence of paid or unpaid assistance for ADL disabilities before PACE enrollment. Hospital admissions in the 6 months before PACE enrollment and acute admissions in the first 6 weeks and the 7th through 12th weeks after enrollment were determined.
  
  
  RESULTS
  Those who lived with unmet ADL needs before enrollment were more likely to have a hospital admission before PACE enrollment (odds ratio (OR) = 1.28, 95% confidence interval (CI) = 1.01-1.63) and an acute admission in the first 6 weeks after enrollment (OR = 1.45, 95% CI = 1.00-2.09) but not after 6 weeks of receiving PACE services (OR = 0.86, 95% CI = 0.53-1.40).
  
  
  CONCLUSIONS
  Frail older people who live without needed help for their ADL disabilities have higher rates of admissions while they are living with unmet ADL needs but not after their needs are met. With state governments under increasing pressure to develop fiscally feasible solutions for caring for disabled older people, it is important that they be aware of the potential health consequences of older adults living without needed ADL assistance.
authors.affiliation: School of Nursing, Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana 47907, USA. lsands@nursing.purdue.edu
authors.forename: Laura P
authors.initials: LP
authors.lastname: Sands
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: George P
authors.initials: GP
authors.lastname: McCabe
authors.forename: Kristofer
authors.initials: K
authors.lastname: Jennings
authors.forename: Catherine
authors.initials: C
authors.lastname: Eng
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data* / Q000639:trends; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies