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Sequence of Functional Loss and Recovery in Nursing Homes
- Source :
- The Gerontologist. 56:52-61
- Publication Year :
- 2015
- Publisher :
- Oxford University Press (OUP), 2015.
-
Abstract
- Purpose of the study This study provides benchmarks for likelihood, number of days until, and sequence of functional decline and recovery. Design and methods We analyzed activities of daily living (ADLs) of 296,051 residents in Veteran Affairs nursing homes between January 1, 2000 and October 9, 2012. ADLs were extracted from standard minimum data set assessments. Because of significant overlap between short- and long-stay residents, we did not distinguish between these populations. Twenty-five combinations of ADL deficits described the experience of 84.3% of all residents. A network model described transitions among these 25 combinations. The network was used to calculate the shortest, longest, and maximum likelihood paths using backward induction methodology. Longitudinal data were used to derive a Bayesian network that preserved the sequence of occurrence of 9 ADL deficits. Results The majority of residents (57%) followed 4 pathways in loss of function. The most likely sequence, in order of occurrence, was bathing, grooming, walking, dressing, toileting, bowel continence, urinary continence, transferring, and feeding. The other three paths occurred with reversals in the order of dressing/toileting and bowel/urinary continence. ADL impairments persisted without any change for an average of 164 days (SD = 62). Residents recovered partially or completely from a single impairment in 57% of cases over an average of 119 days (SD = 41). Recovery rates declined as residents developed more than 4 impairments. Implications Recovery of deficits among those studied followed a relatively predictable path, and although more than half recovered from a single functional deficit, recovery exceeded 100 days suggesting time to recover often occurs over many months.
- Subjects :
- Male
medicine.medical_specialty
Activities of daily living
Bathing
medicine.medical_treatment
Walking
03 medical and health sciences
Cognition
0302 clinical medicine
Risk Factors
030502 gerontology
Activities of Daily Living
Humans
Medicine
030212 general & internal medicine
Geriatric Assessment
Aged
Retrospective Studies
Aged, 80 and over
Minimum Data Set
Rehabilitation
Urinary continence
business.industry
Recovery of Function
General Medicine
United States
Nursing Homes
Toileting
Physical therapy
Female
Geriatrics and Gerontology
Cognition Disorders
0305 other medical science
business
Gerontology
Bandage
Bowel Continence
Subjects
Details
- ISSN :
- 17585341 and 00169013
- Volume :
- 56
- Database :
- OpenAIRE
- Journal :
- The Gerontologist
- Accession number :
- edsair.doi.dedup.....2278c93fb3ea2e45f3d5bb5c9f03ce80