Life-Space of Older Adults after Discharge from Skilled Nursing Facilities

Ayomide Okanlawon Bankole; Ying Zhang; Di Hu; John S Preisser; Cathleen Colón-Emeric; Mark Toles

doi:10.1016/j.jamda.2024.01.006

Life-Space of Older Adults after Discharge from Skilled Nursing Facilities

J Am Med Dir Assoc. 2024 Feb 17:104937. doi: 10.1016/j.jamda.2024.01.006. Online ahead of print.

Authors

Ayomide Okanlawon Bankole¹, Ying Zhang², Di Hu², John S Preisser², Cathleen Colón-Emeric³, Mark Toles²

Affiliations

¹ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: abankole@unc.edu.
² Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Duke University School of Medicine, and Durham VA GRECC, Durham, NC, USA.

PMID: 38378158
DOI: 10.1016/j.jamda.2024.01.006

Abstract

Objectives: Describe (1) patient or caregiver perceptions of physical function in 30 days after skilled nursing facility (SNF) discharge indicated by Life-Space Assessment (LSA) scores, and (2) patient and caregiver factors associated with LSA scores.

Design: Secondary analysis of baseline and outcomes data from the cluster randomized trial of the Connect-Home transitional care intervention.

Setting and participants: Six SNFs in North Carolina. Patient and caregiver dyads with LSA scores (N = 245).

Methods: SNF patients or their caregivers serving as proxy reported the life-space of the SNF patient using the LSA tool, a measure of environmental and social factors that influence physical mobility. Simple scores for highest life-space attained depending on equipment and/or caregiver support range from 0 to 5, with higher scores indicating greater mobility. Multiple linear regression models for simple LSA scores and Composite Life-Space (0-120), adjusted for treatment, time via a COVID pandemic indicator, and treatment × COVID effect as fixed effects, were used to estimate the association of patient and caregiver variables and life-space.

Results: Patients had a mean age of 76.3 years, 62.6% were female, and 74.7% were white. Caregivers were commonly female (73.9%) and adult children of the patient (46.5%). The mean Composite Life-Space score was 22.6 (16.09). The mean Assisted Life-Space score (range: 0-5) was 1.6 (1.47), and 76.3% of patients could not move beyond their bedroom, house, and yard without assistance of another person. Higher Composite Life-Space scores were associated with lower levels of cognitive impairment and shorter SNF length of stay.

Conclusions and implications: SNF patients and their caregivers reported very low LSA scores in 30 days after SNF care. Findings indicate the need for care redesign to promote recovery of physical function of older adults after SNF discharge, such as optimizing SNF rehabilitative therapy and adding postdischarge rehabilitative supports at home.

Keywords: Physical function; caregivers; secondary data analysis; skilled nursing facilities.

Abstract

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