title: The role of functional status in discharge to assisted care facilities and in-hospital death among dialysis patients.
abstract: BACKGROUND
  Functional status is an important component in the assessment of hospitalized patients. We set out to determine the scope, severity, and prognostic significance of impaired functional status in acutely hospitalized dialysis patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  1,286 hospitalized dialysis patients admitted and discharged from 1 of 11 area hospitals in Manitoba, Canada, from September 2003 to September 2010 with an activity of daily living (ADL) assessment within 24 hours of admission.
  
  
  METHODS
  The 12-point ADL score assesses 6 domains (bathing, toileting, dressing, incontinence, feeding, and transferring) and scores them as independent or supervision only (score, 0), partial assistance (1), and full assistance (2). Thus, higher score indicates worse functional status. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics.
  
  
  RESULTS
  Multivariable logistic regression and Cox proportional hazards assessed the association between functional status, in-hospital death, and discharge to an assisted care facility.
  
  
  RESULTS
  During the study period, 250 (19.4%) and 72 (5.6%) patients experienced the outcomes of in-hospital death or discharge to an assisted care facility. Abnormalities in functional status were present in >70% of the cohort. ADL score within 24 hours of admission combined with age differentiated risks of death and discharge to an assisted care facility home, ranging from 4.8%-46.6% and 0.6%-17.8%, respectively. After adjustment, ORs of death and discharge to an assisted care facility were 1.16 (95% CI, 1.11-1.22; P < 0.001; C statistic = 0.79) and 1.25 (95% CI, 1.14-1.36; P < 0.001; C statistic = 0.91) per 1-point increase in ADL score, respectively. Findings were consistent after accounting for the competing outcomes of in-hospital death or discharge to an assisted care facility versus discharge to home.
  
  
  CONCLUSIONS
  A 1-time measurement of ADLs could not differentiate temporary from long-term deterioration in functional status.
  
  
  CONCLUSIONS
  Impaired functional status is common at the time of admission in the dialysis population. A single ADL score measurement at admission combined with age is highly predictive of poor outcomes in the hospitalized dialysis population.
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada. msood99@gmail.com
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Joe
authors.initials: J
authors.lastname: Bueti
authors.forename: Vanita
authors.initials: V
authors.lastname: Jassal
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.forename: Mauro
authors.initials: M
authors.lastname: Verrelli
authors.forename: Clara
authors.initials: C
authors.lastname: Bohm
authors.forename: Julie
authors.initials: J
authors.lastname: Mojica
authors.forename: Dan
authors.initials: D
authors.lastname: Roberts
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D010351:Patient Discharge; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies