Validity of the Sitting Balance Scale in older adults who are non-ambulatory or have limited functional mobility

2012 ◽  
Vol 27 (2) ◽  
pp. 166-173 ◽  
Author(s):  
Mary Thompson ◽  
Ann Medley ◽  
Steve Teran
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Functional Mobility ◽  
Timed Up And Go ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Balance Scale ◽  
Sitting Balance

Objective: To determine whether the Sitting Balance Scale is an acceptable alternative to the Trunk Impairment Scale for measuring the construct of sitting balance, to examine relationships with other clinical outcomes and to establish discriminative validity. Design: Prospective descriptive methodological study. Setting: Acute care, inpatient rehabilitation, skilled nursing facility and home health. Participants: Patients receiving physical therapy ( N = 98; n = 20 acute care, n = 18 inpatient rehabilitation, n = 30 skilled nursing facility, n = 30 home setting) mean (SD) age, 80.5 (7.9) years. Nineteen were non-ambulatory and 79 had limited functional mobility with Timed Up and Go scores ≥20 seconds. Main measures: Sitting Balance Scale, Trunk Impairment Scale, Timed Up and Go, length of stay and setting specific clinical measures of sitting balance (OASIS-C M1850; MDS G-3b). Results: Moderate association between ambulatory status and sitting balance measures (Sitting Balance Scale r = 0.67, Trunk Impairment Scale r = 0.61; P = 0.0001). Moderate to strong relationships between Sitting Balance Scale, Trunk Impairment Scale and clinical outcomes varying by setting. MANOVA results revealed differences between ambulators and non-ambulators and among diagnostic categories for both instruments ( P < 0.001). Conclusions: The Sitting Balance Scale is comparable to the Trunk Impairment Scale for measuring sitting balance in older adults who are non-ambulatory or have limited mobility.

scholarly journals Impact of Self-Care and Mobility on One or More Post-Acute Care Transitions

2020 ◽  
Vol 32 (10) ◽  
pp. 1325-1334
Author(s):  
Chih-Ying Li ◽  
Amol Karmarkar ◽  
Yong-Fang Kuo ◽  
Allen Haas ◽  
Kenneth J. Ottenbacher
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Functional Score ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Facility ◽  
Rehabilitation Facilities ◽  
Inpatient Rehabilitation Facility ◽  
Post Acute Care

Objective: To investigate the association between functional status and post-acute care (PAC) transition(s). Methods: Secondary analysis of 2013–2014 Medicare data for individuals aged ≥66 years with stroke, lower extremity joint replacements, and hip/femur fracture discharged to one of three PAC settings (inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies). Functional scores were co-calibrated into a 0–100 scale across settings. Multilevel logistic regression was used to test the partition of variance (%) and the probability of PAC transition attributed to the functional score in the initial PAC setting. Results: Patients discharged to inpatient rehabilitation facilities with higher function were less likely to use additional PAC. Function level in an inpatient rehabilitation facility explained more of the variance in PAC transitions than function level while in a skilled nursing facility. Discussion: The function level affected PAC transitions more for those discharged to an inpatient rehabilitation facility than to a skilled nursing facility.

scholarly journals 1206. Association of Aging, Frailty and Place of Residence with Skin, Oral and Gut Microbiome Characteristics and Pathogenicity Reservoirs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S625-S625
Author(s):  
Peter J Larson ◽  
Julia Oh ◽  
Julie Robison ◽  
James Grady ◽  
George Kuchel
Keyword(s):  
Older Adults ◽  
Gut Microbiome ◽  
Skilled Nursing Facility ◽  
Antibiotic Resistance Genes ◽  
Community Dwelling ◽  
Colonization Resistance ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Cutibacterium Acnes ◽  
Control And Prevention

Abstract Background Despite their elevated risk for morbidity and mortality from infections, the microbiota of older adults remain understudied. While colonization resistance from resident microflora is a promising means to prevent infections, little is known about pathogenicity reservoirs and colonization resistance in this vulnerable population. Here we study the skin, oral, and gut microbiome dynamics of older adults in both community and Skilled Nursing Facility (SNF) settings, investigating relationships between age, frailty, environment, microbiota, and pathogenicity reservoirs. Methods We conducted a longitudinal metagenome survey of 47 adults age 65+ years of age; 22 residents of 3 different SNFs and 25 community dwelling individuals. We performed metagenomic whole genome shotgun sequencing on stool, oral, and skin samples from 8 sites, 1421 total. To correlate clinical and behavioral variables, we measured frailty, collected medical records, and interviewed participants on diet and lifestyle. We also draw comparisons with previous younger cohorts. Results • Compared to younger adults, the skin microbiota of older adults was characterized by ◦ High heterogeneity ◦ Decreased stability over time, suggesting increased susceptibility to colonization and pathogenicity ◦ Compositional differences including significantly lower levels of Cutibacterium acnes, with reciprocal increases in Staphylococci, Corynebacteria, and Malassezia • In older adults, Frailty (Rockwood) was found to have linear correlation with relative abundance of species relevant to infection risk including acnes, staphylococci, streptococci, E. coli, Akkermansia mucinophila, and Enterococcus faecalis. • The skin, oral, and gut microbiota of SNF residents had substantially elevated virulence factor and antibiotic resistance genes. Conclusion To the best of our knowledge, this is largest report to date of the skin metagenome in older adults. We demonstrate distinct and significant differences between cohorts with clinically relevant implications. We believe these results may inform infection control and prevention by increasing our understanding of colonization resistance and pathogenicity reservoirs, as well as advance our knowledge of the relationship between aging, the microbiome, and infections. Disclosures All Authors: No reported disclosures

scholarly journals Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 666-667
Author(s):  
Indrakshi Roy ◽  
Amol Karmarkar ◽  
Amit Kumar ◽  
Meghan Warren ◽  
Patricia Pohl ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Racial Differences ◽  
Home Health Care ◽  
Multinomial Logistic Regression ◽  
Skilled Nursing Facility ◽  
Ethnic Disparities ◽  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Nursing Facility ◽  
Skilled Nursing

Abstract The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed.

Robotic-assisted total hip arthroplasty: an economic analysis

2021 ◽  
Author(s):  
James Pierce ◽  
Keith Needham ◽  
Chris Adams ◽  
Andrea Coppolecchia ◽  
Carlos Lavernia
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Skilled Nursing Facility ◽  
Health Agency ◽  
Inpatient Rehabilitation ◽  
Cost Index ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Robotic Assisted ◽  
Total Hip

Aim: To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). Methods: THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670 mTHA cases were included. 90-day EOC cost, index costs, length of stay and post-index rehabilitation utilization were assessed. Results: RATHA patients were significantly less likely to have post-index inpatient rehabilitation or skilled nursing facility admissions and used fewer home health agency visits, compared with mTHA patients. Total 90-day EOC costs for RATHA patients were found to be US$785 less than those of mTHA patients (p = 0.0095). Conclusion: RATHA was associated with an overall lower 90-day EOC cost when compared with mTHA. The savings associated with RATHA were driven by reduced utilization and cost of post-index rehabilitation services.

scholarly journals Clinical Courses and Characteristics of Residents During a SARS-CoV-2 Outbreak at a Central Indiana Skilled Nursing Facility

2020 ◽  
Vol 3 ◽  
Author(s):  
Lauren Albert ◽  
Kristi Lieb ◽  
Laramie Mack ◽  
Kathleen Unroe
Keyword(s):  
Older Adults ◽  
Case Reports ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Retrospective Case ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Increased Risk ◽  
Symptom Load ◽  
Retrospective Case Study

Background/Objective: Older adults such as skilled nursing facility residents have increased risk of serious SARS-CoV-2 infection and comprise a large proportion of the COVID-19 pandemic’s deceased—the US Centers for Medicare & Medicaid Services report 232,831 cases and 38,518 resident deaths to date. Recent case reports reveal, as in other diseases, older adults may experience atypical symptomology, complicating identification of ill residents and efforts to slow transmission. While a few facility outbreaks have been characterized epidemiologically, little research exists regarding clinical timelines and trajectories which residents experience during COVID-19 illness.   Methods: From May 9, 2020-June 1, 2020, daily notes on each COVID-19 positive resident’s status (n = 69) were taken by the medical director of a central Indiana nursing facility. Combined with a retrospective resident chart review of this same period, these notes were examined for COVID-19 infection symptoms and illness timelines to descriptively categorize a number of common illness trajectories and symptoms seen in residents with SARS-CoV-2 infection.  Results: Residents fit four descriptive clinical timelines: concurrent symptom load with quick death (Avg 5.6 days) (n = 5), accumulating symptom load with gradual decline (Avg. 13.9 days) (n = 9), prolonged active symptom load with periods of stabilization and symptom reoccurrence (n = 42), and asymptomatic or atypical symptom load (n = 12). Most common symptoms were fever, hypoxia, anorexia, and fatigue/malaise. Of the 14 residents who died (20.3% of infected), 8 died in the facility and 6 died in the hospital.  Conclusion and Implications: This retrospective case study adds to literature describing the presentation and symptomology of SARS-CoV-2 infection in residents of skilled nursing facilities and aids efforts to evaluate resident presentation, prognosis, and disease course. Robust descriptions of expected clinical courses may support realistic expectations of disease progression for residents and their family members experiencing future outbreaks.

scholarly journals Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Vivek Nimgaonkar ◽  
Jeffrey C. Thompson ◽  
Lauren Pantalone ◽  
Tessa Cook ◽  
Despina Kontos ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Acute Care ◽  
Odds Ratio ◽  
Skilled Nursing Facility ◽  
Index Admission ◽  
Composite Outcome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Black Patients ◽  
Post Acute Care

We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.

scholarly journals Impaired Arousal in Older Adults Is Associated With Prolonged Hospital Stay and Discharge to Skilled Nursing Facility

2015 ◽  
Vol 16 (7) ◽  
pp. 586-589 ◽  
Author(s):  
Andrea M. Yevchak ◽  
Jin Ho Han ◽  
Kelly Doherty ◽  
Elizabeth G. Archambault ◽  
Brittany Kelly ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Stay ◽  
Skilled Nursing Facility ◽  
Prolonged Hospital Stay ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Prolonged Hospital
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