title: The effects of resident and nursing home characteristics on activities of daily living.
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.
authors.affiliation: Department of Health Care Administration, Chang Jung Christian University, Taiwan, Republic of China.
authors.forename: Jye
authors.initials: J
authors.lastname: Wang
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Eberly
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.forename: Ling-Hui
authors.initials: LH
authors.lastname: Chang
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006707:Homes for the Aged; D006801:Humans; D015994:Incidence; D008134:Long-Term Care / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008910:Minnesota; D009735:Nursing Homes; D011336:Probability; D011788:Quality of Life; D018570:Risk Assessment; D012678:Sensation Disorders / Q000453:epidemiology; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology