Premorbid Activity Limitation Stages Are Associated With Posthospitalization Discharge Disposition.

The study shows association, not that activity limitation stages caused the discharge location. Other factors may explain the pattern. It could not measure how much post-acute care or rehabilitation each patient actually used, only where they were discharged. It could not separate inpatient rehabilitation from other post-acute services. The stages were from a community survey before hospitalization, not from assessment at admission or discharge, so function may have changed during the hospital stay. ADL and IADL stages were self- or proxy-reported, so recall and reporting bias could misclassify the exposure. The sample was community-dwelling fee-for-service Medicare beneficiaries aged 65 years and older, so it does not apply to managed care enrollees or people already living in facilities. The models did not adjust for all possible confounders, including socioeconomic status and objective cognitive measures. Stage III is a non-fitting stage, so its pattern does not follow the same order as the other stages.

The study used de-identified Medicare Current Beneficiary Survey and claims data. The article reports NIH extramural research support, no personal conflicts of interest, and no disclosures beyond the funding source.

Do not use these stages as a rule that a patient will benefit from inpatient rehabilitation. The study predicted discharge location only, not how much rehabilitation was used or whether function improved.