Frailty and Time at Home After Post-Acute Care in Skilled Nursing Facilities.
Sandra M Shi, Brianne Olivieri-Mui, Gahee Oh and 3 others
PMID 37011886WHAT IT FOUND
Patients with higher pre-admission frailty discharged from skilled nursing facilities were more likely to spend fewer than 173 days at home over the next 6 months, even after age, sex, race, region, comorbidity, function, cognition, and facility factors were considered.
Key findings
0146,240 beneficiaries (32.0%) had short time at home, defined as fewer than 173 days at home in the 6 months after skilled nursing facility discharge.
02Before adjustment, mild frailty was associated with 1.91 times higher odds of short time at home, and moderate to severe frailty with 3.04 times higher odds, compared with nonfrail patients.
03After adjustment for age, sex, race, region, comorbidity, function, cognition, and facility characteristics, mild frailty remained associated with 1.38 times higher odds and moderate to severe frailty with 1.71 times higher odds.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is an observational study of claims data, so it shows association but cannot prove that frailty caused less time at home. Frailty could only be measured in beneficiaries with continuous fee-for-service Medicare for 6 months before admission, so results may not apply to people with Medicare Advantage plans. Claims data may not capture hospital complications, clinical severity, or supportive living environments such as assisted living, leaving residual confounding. Time at home was a novel outcome and was defined as a best-case measure; it does not capture quality of time at home or all health care use. Time at home was imputed for beneficiaries who disenrolled from fee-for-service Medicare.
Declared interests
The article says other authors declared no conflicts of interest. The supplied publication types list NIH extramural research support.
The easy way to misread this
Do not read this as proof that frailty causes less time at home or that extra services after discharge will increase days at home. This was an observational association, not a tested intervention, and residual confounding could explain part of the finding.