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Premorbid Activity Limitation Stages Are Associated With Posthospitalization Discharge Disposition
Ling Na1, Sean Hennessy, Dawei Xie
1From 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).
Premorbid activity limitation stages in older adults predict hospital discharge disposition. Higher limitations correlate with increased need for postacute care services, aiding in resource allocation for elderly Medicare beneficiaries.
Area of Science:
- Gerontology and Geriatric Medicine
- Health Services Research
- Public Health
Background:
- Activity of daily living (ADL) and instrumental activity of daily living (IADL) stages are linked to mortality and healthcare utilization in older adults.
- Understanding premorbid functional status is crucial for predicting post-hospitalization outcomes in community-dwelling elderly individuals.
Purpose of the Study:
- To assess the association between premorbid activity limitation stages and acute hospital discharge disposition among community-dwelling older adults.
- To identify predictors of discharge destination and subsequent healthcare needs in the elderly Medicare population.
Main Methods:
- A cohort study utilizing data from Medicare beneficiaries aged 65 and older enrolled in the Medicare Current Beneficiary Survey (2001-2009).
- Multinomial logistic regression models were employed to estimate associations between premorbid stages and discharge dispositions, adjusting for covariates.
Main Results:
- Among elderly Medicare patients, 59% were discharged home with self-care, 15% home with services, 19% to postacute care facilities, and 7% to other dispositions.
- Higher premorbid ADL and IADL limitation stages significantly increased the adjusted relative risk of discharge to postacute care facilities compared to home with self-care.
- Increased premorbid activity limitations also correlated with a higher likelihood of discharge to home with services.
Conclusions:
- Routinely assessed activity limitation stages effectively predict posthospitalization discharge disposition in older adults.
- These stages can be utilized to anticipate the need for postacute care and services among elderly Medicare beneficiaries, informing care planning and resource allocation.
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