Factors Associated With Skilled Nursing Facility Transfers in Dementia-specific Assisted Living

Abstract

Medical, functional, and behavioral problems are associated with transitions from assisted living (AL), but limited information is available on those at highest risk for transition. We conducted a multidisciplinary geriatric team assessment of individuals newly admitted to 2 dementia-specific AL communities from January 2000 to March 2002. Transitions of individuals to permanent skilled nursing facilities (SNF) was assessed for 9 months. Multidisciplinary assessment on admission included medical and cognitive evaluations, physical function, nutritional status, and psychosocial adjustment. Twenty-four men and 24 women with a mean age of 83+/-6 years were assessed. Mental status score was 15+/-6. Residents had 2.1+/-1.7 comorbidities and were prescribed 1.7+/-1.2 medications. During follow-up, 23 (47.9%) transitioned to SNF and 9 (18.8%) individuals died (censored events). Significant predictors of transfer to nursing home from AL by one-predictor Cox proportional hazards model included depression score [hazard ratio (HR) 1.19; P=0.008], dependent activities of daily living (HR 1.18; P=0.014), gait speed (HR 1.15; P=0.004), modified Berg Balance Score (HR 0.88; P=0.004), and mental status score (HR 0.924, P=0.034). Our multivariate model selected by the forward procedure indicates that the modified Berg Balance Scale score predicted transfer to permanent nursing home with a interquartile HR of 0.91 (95% CI 0.8264, 0.989). A significant number of new residents of dementia-specific AL transitioned to SNF over 9 months. In univariate analysis, depression score, walking speed, balance, and mental status score were significantly associated with transition and in multivariate analysis, balance performance predicted transfer. These results suggest that fall risk should receive attention on admission to AL to potentially mitigate the high transfer rate.