Admission Cognition and Function Predict Change in Physical Function Following Skilled Nursing Rehabilitation.

ABSTRACT

OBJECTIVES: Many older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation. DESIGN: Secondary analysis of a prospective observational cohort study. SETTING AND PARTICIPANTS: Across 4 SNFs, data were collected from 698 adults admitted for physical rehabilitation following an acute hospitalization. METHODS: Physical function recovery was evaluated as change from admission to discharge in Short Physical Performance Battery (SPPB) scores (N = 698) and gait speed (n = 444). Demographic and clinical characteristics collected at admission served as potential predictors of physical function change. Following imputation, a standardized model selection estimator was calculated for predictors per physical function outcome. Predictor estimates and 95% CIs were calculated for each outcome model. RESULTS: Higher cognitive scores [standardized ß (ßSTD) = 0.11, 95% CI 0.0004, 0.20] and higher activities of daily living (ADL) independence at admission (ßSTD = 0.22, 95% CI 0.05, 0.34) predicted greater SPPB change; higher SPPB scores at admission (ßSTD = -0.26, 95% CI -0.35, -0.14) predicted smaller SPPB change. Higher ADL independence at admission (ßSTD = 0.17, 95% CI 0.01, 0.37) predicted greater gait speed change; faster gait speed at admission (ßSTD = -0.30, 95% CI -0.44, -0.15) predicted smaller gait speed change. CONCLUSIONS AND IMPLICATIONS Admission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation.