Trajectories of disability among older persons before and after a hospitalization leading to a skilled nursing facility admission

Bianca M. Buurman, Ling Han, Terrence E. Murphy, Evelyne A. Gahbauer, Linda Leo-Summers, Heather G. Allore, Thomas M. Gill

Research output: Contribution to journalArticleAcademicpeer-review

25 Citations (Scopus)


OBJECTIVES: To identify distinct sets of disability trajectories in the year before and after a Medicare qualifying skilled nursing facility (Q-SNF) admission, evaluate the associations between the pre-and post-Q-SNF disability trajectories, and determine short-term outcomes (readmission, mortality).

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study including 754 community-dwelling older persons, 70+ years, and initially nondisabled in their basic activities of daily living. The analytic sample included 394 persons, with a first hospitalization followed by a Q-SNF admission between 1998 and 2012.

MAIN OUTCOMES AND MEASURES: Disability in the year before and after a Q-SNF admission using 13 basic, instrumental, and mobility activities. Secondary outcomes included 30-day readmission and 12-month mortality.

RESULTS: The mean (SD) age of the sample was 84.9 (5.5) years. We identified 3 disability trajectories in the year before a Q-SNF admission: minimal disability (37.3% of participants), mild disability (44.6%), and moderate disability (18.2%). In the year after a Q-SNF admission, all participants started with moderate to severe disability scores. Three disability trajectories were identified: substantial improvement (26.0% of participants), minimal improvement (36.5%), and no improvement (37.5%). Among participants with minimal disability pre-Q-SNF, 52% demonstrated substantial improvement; the other 48% demonstrated minimal improvement (32%) or no improvement (16%) and remained moderately to severely disabled in the year post-Q-SNF. Among participants with mild disability pre-Q-SNF, 5% showed substantial improvement, whereas 95% showed little to no improvement. Of participants with moderate disability pre-Q-SNF, 15% remained moderately disabled showing little improvement, whereas 85% showed no improvement. Participants who transitioned from minimal disability pre-Q-SNF to no improvement post-Q-SNF had the highest rates of 30-day readmission and 12-month mortality (rate/100 person-days 1.3 [95% CI 0.6-2.8] and 0.3 [95% CI 0.15-0.45], respectively).

CONCLUSIONS: Among older persons, distinct disability trajectories were observed in the year before and after a Q-SNF admission. The likelihood of improvement in disability was greatly constrained by the pre-Q-SNF disability trajectory. Most older persons remained moderately to severely disabled in the year following a Q-SNF admission.

Original languageEnglish
Pages (from-to)225-231
Number of pages7
JournalJournal of the American Medical Directors Association
Issue number3
Publication statusPublished - 1 Mar 2016


  • Aged
  • Aged, 80 and over
  • Disabled Persons
  • Female
  • Hospitalization
  • Humans
  • Interviews as Topic
  • Journal Article
  • Male
  • Patient Readmission
  • Patient Transfer
  • Prospective Studies
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Skilled Nursing Facilities

Cite this