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

急性事件对疗养院居民 ADL 轨迹的影响

• 批准号: 7908674
• 负责人: ROBIN L KRUSE
• 金额: $ 28.01万
• 依托单位: UNIVERSITY OF MISSOURI-COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7908674
• 关键词: Activities of Daily Living; Acute; Admission activity; Affect; Area; Caring; Case Mixes; Categories; Certification; Cessation of life; Characteristics; Climacteric; Cluster Analysis; Communities; County; Coupled; Data; Data Set; Eating; Elderly; Environment; Event; Exhibits; Family; Family Physicians; Goals; Health; Health Resources; Health care facility; Hip Fractures; Hospitalization; Hospitals; Lead; Length of Stay; Life; Life Cycle Stages; Logistic Regressions; Measurement; Measures; Mechanical ventilation; Medicare claim; Modeling; Nursing Homes; Output; Palliative Care; Pathway interactions; Pattern; Physicians; Process; Psyche structure; Quality of life; Recommendation; Records; Recovery; Rehabilitation therapy; Reporting; Research; Resources; Role; Self Care; Sterile coverings; Structure; Surveys; System; Testing; Time; Work; base; cognitive function; cohort; innovation; member; mortality; nursing home length of stay; outcome forecast; partial recovery; prognostic; public health relevance

DESCRIPTION (provided by applicant): Long-stay nursing home residents, those who stay in the facility six months or longer, often remain institutionalized until their death. Intervening illnesses are common, so residents' care goals can evolve dramatically over time. Activities of Daily Living (ADL)-basic personal care activities such as dressing, eating, and mobility-are closely related to health, mortality, and quality of life for nursing home residents. Thus, while no single piece of information can determine care for a resident, change in a resident's ADL status can indicate new care needs as diverse as starting rehabilitation or switching to comfort care. Despite the importance of ADL in the care planning process, we have only a rudimentary understanding of the timing and pattern of ADL change among nursing home residents and the important predictors of these patterns. Moreover, nursing home residents are frequently hospitalized, an event that is often associated with a decline in ADL function. Few studies, however, have examined the relationship between acute hospitalizations and the patterns of ADL change in nursing home residents, particularly the expected ADL course after return to the nursing home. This application proposes to advance the field by examining the patterns of ADL change through time (ADL trajectories). Two large national data sets, Medicare claims data and Minimum Data Set (MDS) assessments, will be used to investigate ADL trajectories for a representative cohort of long-stay nursing home residents. Merging these resident-level data with national data on facilities and health care resources, a multifaceted study of ADL trajectories will be conducted, focusing particularly on the role of acute events involving hospitalization. Aim 1 will begin with hierarchical modeling, with repeated measures of residents' ADL function as the dependent variable. Using the output from these analyses, cluster analysis will be employed to identify ADL trajectory categories (1) preceding and following hospital stays and (2) removed from acute hospitalizations. In Aim 2, the resulting ADL trajectory categories will constitute a dependent variable for multinomial logistic regressions that model post-hospital ADL trajectory categories and mortality conditional on pre-hospital trajectory categories and resident characteristics. Aim 3 will build on Aim 2 by testing the association of facility characteristics (e.g., staffing and rehabilitation environment) with ADL trajectory. Aim 3 will use the same multinomial dependent variable as Aim 2, and also include facility case-mix and resident characteristics as control variables. The results of this innovative study will provide an important first step towards providing residents, nursing home staff, physicians and families the opportunity to include likely ADL trajectories when weighing care options. Such information can help define the appropriate care pathway, whether it is prolonging life, preserving physical and cognitive function, or maximizing comfort. PUBLIC HEALTH RELEVANCE: Although a nursing home resident's ability to perform basic activities such as dressing and eating is important to his or her health and quality of life, we know little about how these abilities change with time or what causes the changes. We propose to study how illnesses that lead to hospitalization affect a resident's ability to perform these important tasks. This research will give residents, physicians, nursing homes, and families important information to help define the resident's main care goals, such as a focus on prolonging life, preserving physical and mental abilities, or maximizing comfort.

描述（由申请人提供）：长期养老院居民，那些六个月或更长时间留在设施的人，通常一直在制度化直到死亡。干预疾病很普遍，因此居民的护理目标可以随着时间的流逝而急剧发展。日常生活（ADL）的活动 - 诸如敷料，饮食和流动性之类的基本个人护理活动与疗养院居民的健康，死亡率和生活质量密切相关。因此，尽管没有一条信息可以确定对居民的护理，但居民的ADL状态的变化可以表明与开始康复或改用舒适护理一样多样化的新护理需求。尽管ADL在护理计划过程中很重要，但我们对疗养院居民中ADL变化的时机和模式以及这些模式的重要预测指标有基本的理解。此外，养老院居民经常住院，这一事件通常与ADL功能下降有关。然而，很少有研究检查急性住院和疗养院居民ADL变化模式之间的关系，尤其是返回到疗养院的预期ADL课程 疗养院。该应用程序建议通过检查通过时间（ADL轨迹）的ADL变化模式来推进该领域。两个大型国家数据集，Medicare索赔数据和最低数据集（MDS）评估，将用于研究代表长期疗养院居民的代表人群的ADL轨迹。将将这些居民级别的数据与有关设施和医疗资源的国家数据合并，将对ADL轨迹进行多方面的研究，特别关注涉及住院的急性事件的作用。 AIM 1将从分层建模开始，重复测量居民的ADL功能作为因变量。使用这些分析的输出，将采用聚类分析来识别ADL轨迹类别（1）前后住院和（2）从急性住院治疗中。在AIM 2中，由此产生的ADL轨迹类别将构成多项式逻辑回归的因变量，该变量对院后ADL轨迹类别和死亡率进行模拟，条件是院前轨迹类别和居民特征。 AIM 3将通过测试ADL轨迹的设施特征（例如人员配备和康复环境）来基于AIM 2。 AIM 3将使用与AIM 2相同的多项式因变量，还包括设施案例和居民 特征作为控制变量。这项创新研究的结果将为为居民，疗养院工作人员，医生和家庭提供重要的第一步，有机会在称重护理选择时包括ADL轨迹。这些信息可以帮助定义适当的护理途径，无论是延长寿命，保留身体和认知功能，还是最大化舒适性。公共卫生相关性：尽管疗养院居民进行诸如穿衣和饮食之类的基本活动的能力对他或她的健康和生活质量很重要，但我们对这些能力如何随着时间的变化或导致变化的原因而了解。我们建议研究导致住院的疾病如何影响居民执行这些重要任务的能力。这项研究将为居民，医师，疗养院和家庭提供重要信息，以帮助定义居民的主要护理目标，例如关注延长寿命，维护身心能力或最大程度地提高舒适感。

项目成果

Functional status of nursing home residents before and after abdominal aortic aneurysm repair.

腹主动脉瘤修复术前后疗养院居民的功能状态。

• DOI: 10.1016/j.jvn.2015.02.003
• 发表时间: 2015
• 期刊: Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing
• 作者: Beffa,LucasR;Petroski,GregoryF;Kruse,RobinL;Vogel,ToddR
• 通讯作者: Vogel,ToddR

Impact of amputation level and comorbidities on functional status of nursing home residents after lower extremity amputation.

截肢水平和合并症对疗养院居民下肢截肢后功能状态的影响。

• DOI: 10.1016/j.jvs.2013.11.076
• 发表时间: 2014
• 期刊: Journal of vascular surgery
• 影响因子: 4.3
• 作者: Vogel,ToddR;Petroski,GregoryF;Kruse,RobinL
• 通讯作者: Kruse,RobinL

Level of disease and association with health status in patients presenting with claudication from the PORTRAIT registry.

肖像登记中跛行患者的疾病水平及其与健康状况的关联。

• DOI: 10.1016/j.jvs.2020.03.042
• 发表时间: 2020
• 期刊: Journal of vascular surgery
• 影响因子: 4.3
• 作者: Vogel,ToddR;Braet,DrewJ;Kruse,RobinL;Bath,Jonathan;Wang,Jingyan;Gosch,Kensey;Smolderen,KimG
• 通讯作者: Smolderen,KimG