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Updated: Jun 26, 2026

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Functional trajectories in older persons admitted to a nursing home with disability after an acute hospitalization
Thomas M Gill1, Evelyne A Gahbauer, Ling Han
1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510, USA. thomas.gill@yale.edu
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.
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