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Clinical Characteristics and Six-Month Outcomes of Nursing Home Residents With Low Activities of Daily Living Dependency

^a Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
^b Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Ann Arbor, Michigan
^c Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
^d University of Michigan Institute of Gerontology, Ann Arbor

Correspondence: Amna Buttar, Department of Medicine, Indiana University School of Medicine, 1001 W. 10^th Street, OPW-M200, Indianapolis, IN 46202 E-mail: abuttar{at}iupu.edu.

Decision Editor: John E. Morley, MB, BCh

Background. Up to 30% of nursing home residents have very little dependency in activities of daily living (ADLs). We compared the characteristics and six-month outcomes of a sample of low-ADL–dependent nursing home residents (LDR) with other residents.

Methods. This is a cross-sectional, six-month follow-up study using secondary data analysis. We combined the separate 1990 and 1993 cohorts in the Resident Assessment Instrument evaluation study. In each case these data were collected in the same 254 nursing homes in 10 states. We studied residents with a length of stay greater than 60 days and age 65 years and older (N = 3955). We compared the baseline characteristics of LDR (n = 985) with all other residents. We then compared six-month outcomes of LDR with other residents and characteristics of LDR with poor outcomes (death or worsened ADL disability) with LDR who remained stable.

Results. The LDR had a significantly decreased frequency of geriatric syndromes (i.e., cognitive impairment, urinary incontinence, under-nutrition, vision problems, poor balance, and pressure ulcers) and neurological disease but had the same frequency of non-neurological chronic diseases and were on more medications. Thirty-one percent had poor six-month outcomes associated with baseline poor cognition, incontinence, poor appetite, and presence of vascular disease, daily pain, shortness of breath, and multiple medications.

Conclusion. Our research identified 29% of nursing home residents with higher physical function (LDR) who had fewer geriatric syndromes and neurological disease diagnoses; 69% of these remained stable at 6 months. Those LDR with a higher risk of poor outcomes could be prospectively identified. LDR who remained stable for 6 months may represent a group who could potentially be maintained in the community.

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