Objectives: To characterize the functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization.
Design: Prospective cohort study of 754 community-living persons aged 70 and older who were initially nondisabled in four essential activities of daily living (ADLs).
Setting: Greater New Haven, Connecticut.
Participants: The analytical sample included 296 participants who were newly admitted to a nursing home with disability after an acute hospitalization.
Measurements: Information on nursing home admissions, hospitalizations, and disability in essential ADLs was ascertained during monthly telephone interviews for up to 9 years. Disability was defined as the need for personal assistance in bathing, dressing, walking inside one's home, or transferring from a chair.
Results: The median time to the first nursing home admission with disability after an acute hospitalization was 46 months (interquartile range 27.5-75.5), and the mean number+/-standard deviation of ADLs that participants were disabled in upon admission was 3.0+/-1.2. In the month preceding hospitalization, 189 (63.9%) participants had no disability. The most common functional trajectory was discharged home with disability (46.3%), followed by continuous disability in the nursing home (27.4%), discharged home without disability (21.6%), and noncontinuous disability in the nursing home (4.4%). Only 96 (32.4%) participants returned home at (or above) their premorbid level of function.
Conclusion: The functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization are generally poor. Additional research is needed to identify the factors responsible for these poor outcomes.