OBJECTIVES. This paper describes 6-year rates and correlates of functional change in the elderly, as well as associated hospital use. METHODS. The Longitudinal Study on Aging (n = 7527) and matched Medicare claims were used to calculate 6-year functional status transition rates and hospital use rates. A hierarchical measure that incorporated activities of daily living, instrumental activities of daily living, and competing risks of institutionalization and death was used to assess functional status. Multinomial logistic regression was used to predict 1990 status. RESULTS. The functional status of 12% of men and women 70 to 79 years of age who were initially impaired in instrumental activities of daily living improved, and about half of the initially independent people in that age group remained so. Multivariate analyses revealed that age, baseline functioning, self-rated health, and comorbidity predicted 1990 status. Both baseline functioning and functional change were related to hospitalization. CONCLUSIONS. This study supports others that have shown some long-term functional improvement, but more commonly decline, in the elderly. Furthermore, it documents the link between functional decline and increased hospital use.
Objective To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations including non-Medicare paid Nursing Home (NH) stays. Data Sources Online Survey Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Denominator, claims (Parts A and B) and MDS assessments for 60,984 people who were present in one of these NHs in 2006. Methods The algorithm creating the RHF is outlined and the RHF for the study data is used to describe place of death. The identification of residents in nursing homes is compared to the reports in OSCAR and part B claims. Principal Findings The RHF correctly identified 84.8% of part B claims with place-of-service in NH, and identified 18.3 less residents on average than reported in the OSCAR on the day of the survey. The RHF indicated that 17.5% non-Medicare NH decedents were transferred to the hospital to die versus 45.6% SNF decedents. Conclusions The population-based design of the RHF makes it possible to conduct policy relevant research to examine the variation in the rate and type of health care transitions across the United States.
Standard functional assessment instruments often fail to capture subtle impairment in community-dwelling older persons. To create a scale to measure function at the Advanced Activities of Daily Living (AADL) level, we chose three questions to separate a community sample into four levels: frequent vigorous exercisers (8.0%), frequent long walkers (10.8%), frequent short walkers (23.7%), and nonexercisers (57.5%). These levels of exercise formed a hierarchical scale that correlated positively in a graduated manner with progressively advanced social activities of daily living, current health status, and mental health. At 1-year follow-up, 20% of persons declined in exercise level, 63% showed no change in exercise level, and 17% improved their exercise level. Changes in exercise level in both directions were associated with changes in mental health status. The Advanced Activities of Daily Living scale may be a sensitive measure of earlier functional decline, but longer follow-up will be necessary to determine its clinical usefulness.
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