Table 1.
Characteristics and Bivariate Associations of Potential Predictors of Recovery of Prehospital Function Among 292 Community-Living Persons Admitted to a Nursing Home With Disability After an Acute Hospitalization
| Characteristic | Operational Details | n (%) or Mean ± SD* | Hazard Ratio† | 95% CI | p Value |
| Demographic | |||||
| Age <85 y | 174 (59.6) | 1.54 | 0.87–2.73 | .14 | |
| Male | 105 (36.0) | 1.56 | 0.86–2.81 | .14 | |
| Non-Hispanic white | 260 (89.0) | 0.84 | 0.33–2.19 | .73 | |
| Lives with others | 144 (49.3) | 1.08 | 0.62–1.87 | .80 | |
| High school education or greater | 184 (63.0) | 1.83 | 1.02–3.25 | .04 | |
| Health related | |||||
| Chronic conditions | 9 self-reported, physician diagnosed‡ | 2.4 ± 1.3 | 1.04 | 0.87–1.24 | .70 |
| Prescription medications | 5.7 ± 2.9 | 1.03 | 0.94–1.13 | .55 | |
| Visual impairment | %, assessed with a Jaeger card | ||||
| None or mild | <6 | 143 (49.0) | 1.21 | 0.66–2.21 | .55 |
| Moderate | 6–26 | 55 (18.8) | 0.81 | 0.38–1.71 | .57 |
| Severe | >26 | 94 (32.2) | Reference | ||
| Hearing impairment | Tones missed out of 4§ | ||||
| None or mild | 0–1 | 76 (26.0) | 1.46 | 0.67–3.17 | .34 |
| Moderate | 2–3 | 109 (37.3) | 1.31 | 0.68–2.52 | .42 |
| Severe | 4 | 107 (36.6) | Reference | ||
| No significant weight loss | ≤10 pounds in past y | 198 (67.8) | 1.91 | 1.06–3.44 | .03 |
| Cognitive–psychosocial | |||||
| Not cognitively impaired | Score on Folstein MMSE ≥24 | 232 (79.5) | 3.44 | 1.69–7.02 | .001 |
| Not depressed | Score on CES-D <20 | 215 (73.6) | 1.38 | 0.74–2.56 | .31 |
| Social support | MOS: 0 (low) to 28 (high) | 21.1 ± 6.0 | 1.01 | 0.96–1.06 | .82 |
| Habitual | |||||
| Not current smoker | 268 (91.8) | 1.07 | 0.41–2.79 | .89 | |
| Physical activity not low | PASE score ≥64 for men and ≥52 for women‖ | 91 (31.2) | 1.48 | 0.81–2.71 | .20 |
| Body mass index | Self-reported height and weight¶, kg/m2 | ||||
| Normal or underweight | <25 | 138 (47.3) | Reference | ||
| Overweight | 25–29.9 | 91 (31.2) | 1.11 | 0.57–2.17 | .75 |
| Obese | ≥30 | 63 (21.6) | 2.18 | 1.13–4.22 | .02 |
| Physical capacity# | |||||
| Gait speed not slow | ≤10 s on rapid gait test | 198 (67.8) | 1.42 | 0.71–2.86 | .32 |
| Gait and balance | Modified POMA: 0 (poor) to 12 (good)** | 5.8 ± 1.7 | 1.24 | 1.05–1.46 | .01 |
| Able to rise from chair | In single attempt with arms folded | 138 (47.3) | 1.22 | 0.69–2.17 | .50 |
| Timed chair stands††, s | Up and down three times | ||||
| <7.6 | 20 (6.9) | 6.04 | 2.23–16.3 | <.001 | |
| 7.6–9.0 | 33 (11.3) | 2.22 | 0.86–5.77 | .10 | |
| 9.1–11.9 | 77 (26.4) | 2.11 | 1.13–3.97 | .02 | |
| ≥12.0 | 162 (55.5) | Reference | |||
| SPPB | 0 (low) to 12 (high) | 4.7 ± 2.5 | 1.22 | 1.08–1.39 | .002 |
| Manual dexterity††, s | 9-hole pegboard test | ||||
| <21.8 | 19 (6.5) | 26.1 | 9.36–73.0 | <.001 | |
| 21.8–24.3 | 35 (12.0) | 4.04 | 1.62–10.0 | .003 | |
| 24.4–27.5 | 50 (17.1) | 1.94 | 0.90–4.19 | .09 | |
| ≥27.6 | 188 (64.4) | Reference | |||
| Gross motor coordination††, s | 10 finger taps as described in the text | ||||
| <8.8 | 27 (9.3) | 25.8 | 9.20–72.1 | <.001 | |
| 8.8–10.3 | 47 (16.1) | 2.96 | 1.37–6.38 | .01 | |
| 10.4–12.4 | 74 (25.3) | 1.96 | 0.97–3.97 | .06 | |
| ≥12.5 | 144 (49.3) | Reference | |||
| Grip strength not poor‡‡ | Handheld dynamometer | 74 (25.3) | 0.96 | 0.49–1.85 | .89 |
Notes: CES-D = Center for Epidemiological Studies-Depression scale; CI = confidence interval; MMSE = Mini-Mental State Examination; MOS = Medical Outcomes Survey Social Support Scale; PASE = Physical Activity Scale for the Elderly; POMA = Performance-Oriented Mobility Assessment; SPPB = Short Physical Performance Battery.
Values are provided from the comprehensive assessment that was completed immediately prior to the first index nursing home admission.
Hazard ratios were estimated using recurrent event Cox regression counting process models, adjusted for the number of months from the preceding comprehensive assessment to the index nursing home admission. Among the 292 participants, there were 364 index nursing home admissions. Hazard ratios for continuous variables are per one unit increase.
Hypertension, myocardial infarction, heart failure, stroke, diabetes mellitus, arthritis, hip fracture, chronic lung disease, and cancer (other than minor skin cancers).
Based on 1000 and 2000 Hz measurements for the left and right ears.
These gender-specific cut-points denote the worse quintile of scores among the first 356 enrolled participants, who had been selected randomly from our source population of health plan members, as previously described (17).
Body mass index was categorized into three groups based on published cut-points, as previously described (25).
Participants were asked to perform each of the timed tests as quickly (and safely) as possible.
Includes 5 gait items—step continuity and symmetry, path deviation, turning, and missed steps—and the three standard tasks of standing balance from the Established Population for Epidemiologic Studies of the Elderly battery, as previously described (21).
Because standard cut-points have not been established for these timed tests, quartile scores were calculated based on the first 356 enrolled participants and subsequently applied to the entire cohort.
Value less than or equal to the gender- and body mass index–specific cut-points provided by Fried and coworkers (26).