The Effects of Acute Events on ADL Trajectories
of Nursing Home Residents

Unlike many older adults who enter nursing homes for rehabilitation and then return to the community, those who remain in nursing homes for long stays (six months or more) usually remain in institutional care until their deaths. Consequently, their overall care goals may evolve dramatically over time. For many residents, one particularly important factor influencing care decisions is the trajectory (pattern of change over time) of their ability to perform Activities of Daily Living (ADL) - basic personal care activities, such as dressing, eating, and moving about. Because acute hospitalization is often associated with at least a transient decline in ADL, residents' pre-admission trajectory may inform decisions for restoring or maintaining function where appropriate. Similarly, when residents return to their nursing homes, good care planning demands that physicians and other care team members have a clear sense of residents' expected ADL trajectories. These could vary widely from continued decline to a reasonable potential for recovery. For example, following a hip fracture, a resident's physician or facility staff might suggest intensive rehabilitation when the prognosis for recovery is fair or good, but they might suggest emphasizing comfort measures if they expect continued decline.

Despite the potential benefits, little evidence exists about the ADL trajectories of nursing home residents, particularly as they are influenced by hospitalization. As a result, physicians and facility staff are forced to use guesswork to develop care plans. This study will take an important first step toward supplying nursing homes and physicians with the information they need to make well-informed care recommendations.

Using national datasets, we will merge resident-level data from nursing home assessments and Medicare claims data, records on nursing home structure and staffing characteristics, and county-level information on health resources to examine the patterns of change of Activities of Daily Living (ADL) of long-stay nursing home residents. We will use these data to:
1. Identify distinct ADL trajectories for nursing home residents surrounding hospital stays.
2. Determine how resident characteristics and pre-hospital ADL trajectory affects post-hospital trajectory and mortality.
3. Determine the relationship between facility characteristics (e.g., staffing and rehabilitation environment) and residents' post-hospital ADL trajectory categories.

For more information, contact:
Robin Kruse, PhD

(Return to Current Research Projects)