Sequence of Functional Loss and Recovery in Nursing Homes.
OBJECTIVE
This study provides benchmarks for likelihood, number of days until, and sequence of functional decline and recovery.


METHODS
We analyzed activities of daily living (ADLs) of 296,051 residents in Veteran Affairs nursing homes between January 1, 2000 and October 9, 2012. ADLs were extracted from standard minimum data set assessments. Because of significant overlap between short- and long-stay residents, we did not distinguish between these populations. Twenty-five combinations of ADL deficits described the experience of 84.3% of all residents. A network model described transitions among these 25 combinations. The network was used to calculate the shortest, longest, and maximum likelihood paths using backward induction methodology. Longitudinal data were used to derive a Bayesian network that preserved the sequence of occurrence of 9 ADL deficits.


RESULTS
The majority of residents (57%) followed 4 pathways in loss of function. The most likely sequence, in order of occurrence, was bathing, grooming, walking, dressing, toileting, bowel continence, urinary continence, transferring, and feeding. The other three paths occurred with reversals in the order of dressing/toileting and bowel/urinary continence. ADL impairments persisted without any change for an average of 164 days (SD = 62). Residents recovered partially or completely from a single impairment in 57% of cases over an average of 119 days (SD = 41). Recovery rates declined as residents developed more than 4 impairments.


CONCLUSIONS
Recovery of deficits among those studied followed a relatively predictable path, and although more than half recovered from a single functional deficit, recovery exceeded 100 days suggesting time to recover often occurs over many months.
Veterans Administration Eastern Colorado Health Care System, Denver.
Cari R
CR
Levy
School of Management, University of San Francisco, California.
Manaf
M
Zargoush
Bay Pines Veterans Administration Healthcare System, Florida.
Allison E
AE
Williams
Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Administration Medical Center, Tampa, Florida.
Arthur R
AR
Williams
Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
Phan
P
Giang
Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
Janusz
J
Wojtusiak
District of Columbia Veterans Administration Medical Center, Washington.
Raya E
RE
Kheirbek
Department of Health Administration and Policy, George Mason University, Fairfax, Virginia. District of Columbia Veterans Administration Medical Center, Washington. falemi@gmu.edu.
Farrokh
F
Alemi
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000503:physiopathology*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009735:Nursing Homes; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D016138:Walking / Q000502:physiology*
Barthel Index; Functional status; Long-term care; Prognosis; Rehabilitation