Inpatient Mobility Measures As Useful Predictors of Discharge Destination in Hospitalized Older Adults
Year: 2017
Type: article
Abstract: To the Editor: Postacute care skilled nursing facility (SNF) stays are frequent and costly for the more than 13.6 million older adults who are discharged annually from nonfederal U.S. hospitals.1-3 An important determinant of the need for postacute care in a SNF setting is an individual's functional ability.4 Mobility status, a distinct aspect of functional ability, may be particularly useful in identifying hospitalized older adults who are likely to need posthospital SNF care. Mobility can be measured through observed performance-based or self-reported measures.5-8 Lacking from the literature is knowledge of which mobility measures in the inpatient setting are predictive of important hospital outcomes. The specific aim of this study was to determine whether performance-based and self-reported measures of mobility could distinguish individuals discharged to a SNF from those discharged home. This study was a secondary analysis of a clinical dataset containing information on 349 community-dwelling hospitalized veterans aged 60 and older admitted to general medicine services at an academic Department of Veterans Affairs (VA) medical center and referred to STRIDE, a supervised walking program,9 between February 1, 2012, and September 30, 2013, with a baseline assessment. All data were abstracted from the electronic health records of the VA Computerized Patient Record System. The primary outcome assessed was discharge destination, defined as home or a SNF (community SNF, VA nursing home (Community Living Center), other skilled care facility). Performance-based measures of mobility, which a trained physical therapist obtained, included gait speed (4 categories, m/s), 2-minute walk test (2MWT) (meters), and the Tinetti Performance Oriented Mobility Assessment (POMA) balance subscale (range 0–16).7 Self-reported mobility indices included any report of difficulty walking across a room without help from another person or equipment (none, a little vs some, a lot, unable), difficulty walking two to three blocks without help from another person or equipment (none, a little vs some, a lot, unable), and use of assistive device (yes vs no). Logistic regression analyses were performed to examine associations between mobility measures and discharge to a SNF. All analyses were performed using SAS version 9.3 (SAS Institute, Inc., Cary, NC). Characteristics of the study sample (N = 349) and bivariate analyses are presented in Table 1. Individuals discharged to a SNF after hospitalization (15%, n = 53) were more likely to have slower gait speed, shorter 2MWT distance, and lower balance subscale score than those discharged home. Individuals in this group were also more likely to report difficulty walking across a room and use of an assistive device (Table 1). After controlling for age and race, the adjusted odds of being discharged to a SNF were greater for individuals with slower gait speed (odds ratio (OR) = 1.62 per 1-category slower gait speed, 95% confidence interval (CI) = 1.22–2.15, P ≤ .001) poorer balance (OR = 1.20 per 1-point lower balance subscale score, 95% CI = 1.10–1.30, P ≤ .001), and shorter 2MWT distance (OR = 1.01 per meter, 95% CI = 1.00–1.01, P = .007), with every 1-m decrease in 2MWT associated with 1% greater odds of discharge to a SNF. Individuals reporting the use of an assistive device had 2.6 greater odds (95% CI = 1.31–5.17, P = .006) of being discharged to a SNF, and those reporting difficulty walking across a room had 2.4 greater odds (95% CI = 1.19–5.04, P = .02) (Table 1). In community-dwelling hospitalized older adults who were ambulatory at baseline, inpatient mobility, a discrete aspect of functional status, predicted discharge destination. This study contributes to the nascent literature on the clinical utility of inpatient mobility measures in important ways. First, the findings suggest that performance-based and self-reported mobility measures may identify individuals who are likely to be discharged to a SNF. Identifying those at risk of being discharged to a SNF could be of tremendous value to health systems and hospital providers, who are interested in conserving limited hospital resources (physical therapy or care transitions teams) for those who need them most. Second, the findings indicate that easily attainable and recordable self-reported indices of mobility are feasible to collect in the course of clinical care. These data can also serve as a springboard for future studies, including a more-comprehensive examination of the predictive ability of other mobility performance measures and functional trajectories during hospitalization. The authors acknowledge Mimi McCarty for assistance with data collection. Conflict of Interest: None. Financial Disclosure: Internal support was received from the Durham VA Center for Health Services Research in Primary Care; the Durham VA Geriatrics Research, Education and Clinical Center; the Duke Older Americans Independence Center (NIA P30 AG028716–01); and the VA Office of Geriatrics and Extended Care (T21 Non-Institutional Care Pilot 558–3). Portions of this work were conducted while Dr. Pavon was supported by the T. Franklin Williams Scholars Program. The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. government. Previously presented at the Society of Hospital Medicine Annual Meeting, National Harbor, Maryland, March 29 to April 1, 2015, and the American Geriatrics Society Annual Meeting, National Harbor, Maryland, May 14 to 17, 2015. Author Contributions: Pavon J., Hastings S. N.: Study concept and design. Sloane R., Pavon J., Hastings S. N., Morey M.: Data analysis and interpretation. Pavon J., Sloane R., Morey M., Hastings S. N.: Preparation of manuscript. Pavon J., Sloane R., Morey M., Hastings S. N.: Final approval of manuscript. Sponsor's Role: None.
DOI: 10.1111/jgs.14577
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2580466577