Work

Improvement in Activities of Daily Living during a Nursing Home Stay and One‐Year Mortality among Older Adults with Sepsis

Year: 2020

Type: article

Abstract: BACKGROUND/OBJECTIVE: To describe the recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and the association with 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. DESIGN: Retrospective cohort study. SETTING: Skilled nursing facilities in the United States. PARTICIPANTS: Medicare fee-for-service beneficiaries admitted to an SNF within 3 days of discharge from a hospitalization that included an intensive care unit (ICU) stay for sepsis between January 1, 2013, and September 30, 2015 (N = 59,383). MEASUREMENTS: Data from the Minimum Data Set (MDS) were used to calculate a total score for seven ADLs. Improvement was determined by comparing the total ADL scores from the first and last MDS assessments of the SNF stay. Proportional hazard models were used to estimate the association between improvement in ADL function and 1-year mortality after SNF discharge. RESULTS: Approximately 58% of SNF residents had any improvement in ADL function. Residents who had improvement in ADL function had 0.72 (95% confidence interval (CI) = 0.69-0.74) lower risk for mortality following SNF discharge than residents who did not improve. Residents who improved 1-3 points (hazard ratio (HR) = 0.82, 95% CI = 0.79-0.84) and four or more points (HR = 0.57, 95% CI = 0.55-0.60) in ADL function had significantly lower mortality risk than residents who did not improve. CONCLUSION: Older adults treated in an ICU with sepsis can improve in ADL function during an SNF stay. This improvement is associated with lower 1-year mortality risk after SNF discharge. These findings provide evidence that ADL recovery during an SNF stay is associated with better health outcomes for older adults who have survived an ICU stay for sepsis.

Source: Journal of the American Geriatrics Society

DOI: 10.1111/jgs.16915

Authors: Brian Downer, Kevin Pritchard, Kali S. Thomas, Kenneth Ottenbacher

Institutions: The University of Texas Medical Branch at Galveston, United States Department of Veterans Affairs, Brown University, Veterans Health Administration, Providence VA Medical Center

Language: English

Topic: Geriatric Care and Nursing Homes

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: U.S. Department of Veterans Affairs, Agency for Healthcare Research and Quality, National Institute on Aging, Eunice Kennedy Shriver National Institute of Child Health and Human Development