Illness Trajectories Among Nursing Home Residents (TH318-D)

Abstract

Objectives Understand trajectories of illness among nursing home residents and how these differ from traditional trajectories in general populations. Understand how trajectories different comorbid conditions, independent of age. Original Research Background: By 2020, 40% of all deaths in the United States are expected to occur in nursing homes. Trajectories of illness prior to death have traditionally been defined using four general patterns to include (a) sudden death, (b) a short period of decline, (c) long-term limitations with intermittent serious episodes, and (d) prolonged dwindling. Research Objectives: The purpose of this study was to determine if these trajectories are observed among a cohort of nursing home residents. Methods: and analyzed within the VA Informatics and Computing Infrastructure. Data included diagnoses from 1,617,693 inpatient records; 145,575,072 outpatient visits; and 1,901,354 functional status evaluations given as the Minimum Dataset (MDS). The Barthel Index was constructed from MDS Data using nine ADLs (stair climbing was excluded). Diagnoses originally present as ICD-9 codes were converted to Charlson Comorbidity Categories (Deyo version). Results: A total of 144 trajectories were analyzed for combinations of Charlson comorbidities and Barthel Index items. Daily likelihood ratios (probabilities) of ADL impairments were calculated for the 5-year period preceding MDS evaluation to form trajectories of decline over that period. Four general patterns of trajectories were identified: 1. Steady decline—MI, dementia, renal failure, diabetes, peptic ulcer