The subsequent course of disability in older persons discharged to a skilled nursing facility after an acute hospitalization

Abstract

Objectives: To evaluate the association between the type of acute hospitalization and subsequent course of disability in older persons discharged to a skilled nursing facility (SNF).

Design: Longitudinal study of 754 community-living persons aged 70 or older.

Participants: The analytical sample included 365 participants who had one or more admissions to a SNF after an acute hospitalization (n=520 index admissions).

Measurements: Information on hospitalizations, SNF admissions, and disability was ascertained over 15years. The primary and secondary outcomes were disability burden and recovery of pre-hospital function, respectively, assessed monthly over a 6-month period. Index admissions were classified into four mutually exclusive groups based on the type of hospitalization: elective major surgery, non-elective major surgery, critical illness, and other.

Results: Disability worsened considerably after hospitalization for each of the four groups. Relative to elective major surgery, the disability burden over 6months was significantly greater for non-elective major surgery, critical illness, and other hospitalizations, with adjusted rate ratios (RRs) of 1.37 (95% CI 1.19 to 1.59), 1.37 (95% CI 1.19 to 1.58), and 1.29 (95% CI 1.14 to 1.47), respectively. Overall, recovery to pre-hospital function was observed in only 132 (25.4%) admissions. Relative to elective major surgery, the likelihood of recovering pre-hospital function was considerably lower for each of the three other groups. The results were consistent for basic, instrumental and mobility activities.

Conclusion: Among older persons discharged to a SNF after an acute hospitalization, the functional course over 6months was generally poor, with recovery to pre-hospital function observed in only one out of every four cases. Relative to elective major surgery, functional outcomes were worse for non-elective major surgery, critical illness, and other hospitalizations.

Keywords: Disability burden; Functional recovery; Hospitalization; Older; Skilled nursing facility.

Figure 1

Assembly of the analytic sample from the parent cohort.

Figure 2

The longitudinal course of disability in all 13 functional activities over the 6-month follow-up period according to the type of acute hospitalization. Values represent the mean number of disabilities, accompanied by 95% confidence intervals (CI). 0 on the x-axis denotes preadmission to the hospital. Data were missing for 1 admission (observation) at 6 months in the other hospitalizations group.