Factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization.
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.
Gill
Thomas M
TM
Department of Internal Medicine, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504, USA. thomas.gill@yale.edu
Gahbauer
Evelyne A
EA
Han
Ling
L
Allore
Heather G
HG
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003266:Continuity of Patient Care; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011336:Probability; D016016:Proportional Hazards Models; D020127:Recovery of Function / Q000502:physiology*; D012307:Risk Factors; D013997:Time Factors; D014481:United States