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Premorbid Activity Limitation Stages Are Associated With Posthospitalization Discharge Disposition

Na, Ling PhD; Hennessy, Sean PharmD, PhD; Xie, Dawei PhD; Saliba, Debra MD, MPH, AGSF; Pan, Qiang MA; Kwong, Pui L. MPH; Kurichi, Jibby E. MPH; Bogner, Hillary R. MD, MSCE; Streim, Joel E. MD

American Journal of Physical Medicine & Rehabilitation: June 2018 - Volume 97 - Issue 6 - p 440–449
doi: 10.1097/PHM.0000000000000896
Original Research Articles
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Objective Activity of daily living stages and instrumental activity of daily living stage have demonstrated associations with mortality and health service use among older adults. This cohort study aims to assess the associations of premorbid activity limitation stages with acute hospital discharge disposition among community-dwelling older adults.

Design Study participants were Medicare beneficiaries aged 65 yrs or older who enrolled in the Medicare Current Beneficiary Survey between 2001 and 2009. Associations of premorbid stages with discharge dispositions were estimated with multinomial logistic regression models adjusted for covariates.

Results The proportions of elderly Medicare patients discharged to home with self-care, home with services, postacute care facilities, and other dispositions were 59%, 15%, 19%, and 7%, respectively. The following adjusted relative risk ratios and 95% confidence intervals of postacute care facilities versus home with self-care discharge increased with higher premorbid activity limitation stages (except nonfitting stage III): 1.7 (1.5–2.0), 2.4 (2.0–2.9), 2.4 (1.9–3.0), and 2.5 (1.6–4.1) for activity of daily living stages I–IV; a similar pattern was found for instrumental activity of daily living stages. The adjusted relative risk ratios of discharge to home with services also increased with higher premorbid activity limitation stages compared with no limitation.

Conclusions Routinely assessed activity limitation stages predict posthospitalization discharge disposition among older adults and may be used to anticipate postacute care and services use by elderly Medicare beneficiaries.

From the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (LN, SH, DX, QP, PLK, JEK, HRB); Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, Pennsylvania (SH); U.S. Department of Veterans Affairs, Geriatrics Research Education and Clinical Center, Los Angeles, California (DS); Borun Center, UCLA Department of Medicine, University of California, Los Angeles, California (DS); RAND, Santa Monica, California (DS); and Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (JES).

All correspondence should be addressed to: Joel E. Streim, MD, Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Ralston-Penn Center, 3615 Chestnut St, Philadelphia, PA 19104-2676.

The research for this article was supported by the grant from the National Institutes of Health (R01AG040105). There are no personal conflicts of interest of any of the authors, and no authors reported disclosures beyond the funding source. The opinions and conclusions of the authors are not necessarily those of the sponsoring agency. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated. This material has not been previously presented at a meeting.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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