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

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.