Abstract
Background and Purpose: Inability to obtain sufficient gains in function during a skilled nursing facility (SNF) stay impacts patients' functional trajectories and susceptibility to adverse events. The purpose of this study was to identify predictors of functional change in patients temporarily residing in an SNF following hospitalization. Methods: One hundred forty patients admitted to a single SNF from the hospital who had both evaluation and discharge measures of physical function documented were included. Data from the Minimum Data Set 3.0 and electronic medical record were extracted to record clinical and demographic characteristics. The Short Physical Performance Battery (SPPB) was administered by rehabilitation therapists at evaluation and discharge. The SPPB consists of balance tests, gait speed, and a timed 5-time sit-to-stand test. Results and Discussion: The Patient Health Questionnaire (PHQ-9) Screening Tool for Depression was the only significant predictor of change in gait speed over an SNF stay. Eighty-seven percent of patients achieved a clinically meaningful change in the SPPB of 1 point or greater from evaluation to discharge, with 78% demonstrating a clinically meaningful change of 0.1 m/s or greater on gait speed. However, 69% of patients demonstrated SPPB scores of 6 points or less and 57% ambulated less than 0.65 m/s at the time of discharge from the SNF, which indicates severe disability. Conclusions: Poor physical function following an SNF stay places older adult at significant risk for adverse events including rehospitalization, future disability, and institutionalization. Understanding the predictors of functional change from evaluation to discharge may direct efforts toward developing innovative and effective interventions to improve function trajectories for older adults following an acute hospitalization.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 189-195 |
| Number of pages | 7 |
| Journal | Journal of Geriatric Physical Therapy |
| Volume | 42 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jul 1 2019 |
| Externally published | Yes |
Bibliographical note
Funding Information:1Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora. 2Denver Veterans Affairs Medical Center, Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado. 3Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado. This study and the waiver of consent were approved by Denver Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Denver, Colorado the Colorado Multiple Institutional Review Board (14-2388). This research was funded in part by the Promotion of Doctoral Studies I from the Foundation for Physical Therapy (to A.M.G. and J.R.F.); the Fellowship for Geriatric Research from the Academy of Geriatric Physical Therapy (to A.M.G.); the Integrative Physical of Aging Training grant T32AG000279 (to A.M.G. and J.R.F.); and the Rehabilitation Research & Development Small Projects in Rehabilitation Research I21 RX002193 from the U.S. Department of Veteran Affairs (to J.E.S.L.). The authors have no conflicts of interest to declare. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jgpt.org). Address correspondence to: Jennifer E. Stevens-Lapsley, PT, PhD, University of Colorado, Department of Physical Medicine and Rehabilitation, Physical Therapy Program 13121 East 17th Ave, Aurora, CO 80045 (Jennifer.stevens-lapsley@ucdenver.edu). Richard Bohannon was the Decision Editor. Copyright © 2017 Academy of Geriatric Physical Therapy, APTA.
Publisher Copyright:
© 2019 Journal of Geriatric Physical Therapy. All rights reserved.
Keywords
- older adults
- physical therapy
- post-acute care
- rehabilitation
- subacute