This study was a longitudinal analysis of a representative sample of nursing home residents in one US state. MDS assessments for residents with a length of stay of greater than 90 days in the year 2002 were collected from a US National Resident Assessment Instrument database (n = 66,742) and follow-up data were extracted at three and six months [21 ]. We chose three month intervals between assessments to enable more precise examination of the rate and direction of change than is available in many longitudinal studies with assessment intervals of a year or more [22 (link),23 ]. Residents with an expectation of being discharged prior to 90 days were excluded (n = 1998).
In order to minimise the effect of factors, other than cognitive impairment, in relation to change in ADL, residents were excluded if they had specific co-morbid diseases or conditions, or received specific treatments. These included history of learning disability, decreased auditory and visual acuity, problems with expressive speech, hypotension, seizure disorder, traumatic brain injury, manic depression, schizophrenia, HIV infection, septicaemia, weight fluctuation, inability to lay flat due to shortness of breath, dehydration, insufficient fluid consumption, internal bleeding, recurrent lung aspiration, end stage of disease, feeding by parenteral/IV or feeding tube, treatment including chemotherapy, radiation, tracheotomy care, transfusion, ventilator, for alcohol/drug problems, hospice care and respite care. Residents with concurrent or pre-existing limitations to mobility such as hip fracture, missing limb, bone fracture, cerebral palsy, stroke, hemiplegia/paresis, multiple sclerosis, paraplegia, Parkinson disease, or quadriplegia were also excluded. After applying these exclusions, the total number of residents available for study was 21,670. The most common reasons for exclusion were stroke (23%), presence of a learning disability (19%), impaired vision (10%) and hip fracture (5%). Nearly 40% of the sample had two or more of these exclusion criteria.
In order to minimise the effect of factors, other than cognitive impairment, in relation to change in ADL, residents were excluded if they had specific co-morbid diseases or conditions, or received specific treatments. These included history of learning disability, decreased auditory and visual acuity, problems with expressive speech, hypotension, seizure disorder, traumatic brain injury, manic depression, schizophrenia, HIV infection, septicaemia, weight fluctuation, inability to lay flat due to shortness of breath, dehydration, insufficient fluid consumption, internal bleeding, recurrent lung aspiration, end stage of disease, feeding by parenteral/IV or feeding tube, treatment including chemotherapy, radiation, tracheotomy care, transfusion, ventilator, for alcohol/drug problems, hospice care and respite care. Residents with concurrent or pre-existing limitations to mobility such as hip fracture, missing limb, bone fracture, cerebral palsy, stroke, hemiplegia/paresis, multiple sclerosis, paraplegia, Parkinson disease, or quadriplegia were also excluded. After applying these exclusions, the total number of residents available for study was 21,670. The most common reasons for exclusion were stroke (23%), presence of a learning disability (19%), impaired vision (10%) and hip fracture (5%). Nearly 40% of the sample had two or more of these exclusion criteria.
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