Objectives: Improving function is an important outcome of postacute care in skilled nursing facilities (SNFs), but cognitive impairment can limit a resident's ability to improve during a postacute care stay. Our objective was to examine the association between residents’ cognitive status on admission and change in self-care and mobility during a Medicare-covered SNF stay. Design: Retrospective analysis of Medicare beneficiaries who had a new SNF stay between January and June 2017. Setting: SNFs in the United States. Participants: Newly admitted residents with Medicare-covered SNF stays between January and June 2017 (n = 246 395). Measurements: Residents’ self-care and mobility at SNF admission and discharge were determined using items from Section GG (eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting, sit to stand, chair/bed transfer, and toilet transfer) of the Minimum Data Set. Residents were classified as cognitively intact, mildly impaired, moderately impaired, or severely impaired, according to the Cognitive Function Scale. Multivariable regression models controlling for residents’ demographic and clinical characteristics and SNF fixed effects were used to identify residents whose discharge scores for self-care and mobility were better or the same as expected according to their cognitive status on admission. Results: Residents who were cognitively impaired on admission had lower functional status on admission and were less likely to improve in self-care and mobility compared with residents who were cognitively intact. Approximately 63% of residents who were cognitively intact had discharge scores for self-care and mobility that were better or the same as expected compared with 45% of residents with severe cognitive impairment. Conclusions: Cognitive impairment is associated with poorer self-care and mobility function among SNF residents. These findings have important implications for clinicians, who may need additional support when caring for residents with cognitive impairment to make the same improvements in functional status as residents who are cognitively intact. J Am Geriatr Soc 67:553–557, 2019.
Bibliographical noteFunding Information:
Financial Disclosure: This study was funded by P01A G027296 from the US National Institute on Aging. Ms. Loomer’s time is supported by NIH-NIA 2T32AG023482-13. Dr. Downer’s time is covered by the University of Texas Medical Branch Pepper Center (NIA P30AG024832-14). Dr. Thomas’s time is covered by a Career Development Award from the Veterans Health Administration (CDA14-422).
This study was funded by P01AG027296 from the US National Institute on Aging. Ms. Loomer's time is supported by NIH-NIA 2T32AG023482-13. Dr. Downer's time is covered by the University of Texas Medical Branch Pepper Center (NIA P30AG024832-14). Dr. Thomas's time is covered by a Career Development Award from the Veterans Health Administration (CDA14-422). The authors have no conflicts of interest to disclose. Author Contributions: Study concept and design: Loomer, Downer, and Thomas. Acquisition of data: Thomas. Analysis and interpretation of data: Loomer, Downer, and Thomas. Preparation of the manuscript: Loomer, Downer, and Thomas. Funding sources did not have any role in the design, methods, subject recruitment, data collections, analysis, or preparation of the article.
© 2018 The American Geriatrics Society
- cognitive impairment
- functional status
- nursing homes
- quality measures