Long-term care residents’ geriatric syndromes at admission and disablement over time: an observational cohort study

Background — Disablement occurs when people lose their ability to perform activities of daily living (ADLs) like bathing and dressing, and is measured as the rate of increasing disability over time. We examined whether balance impairment, cognitive impairment or pain among residents at admission to long-term care homes were predictive of their rate of disablement over the subsequent two years.

Methods — Linked administrative databases were used to conduct a longitudinal cohort study of 12,334 residents admitted to 633 long-term care (LTC) homes between April 1st 2011 and March 31st 2012, in Ontario, Canada. Residents received an admission assessment of disability upon admission to LTC using the RAI-MDS 2.0 ADL long-form score (ADL LFS, range 0 – 28) and at least two subsequent disability assessments. Multivariable regression models estimated the adjusted association between balance impairment, cognitive impairment and pain present at admission and residents' subsequent disablement over two years.

Results — This population sample of newly admitted Ontario long-term care residents had a median disability score of 13 (IQR= 7, 19) at admission. Greater balance impairment and cognitive impairment at admission were significantly associated with faster resident disablement over two years in adjusted models, while daily pain was not.

Conclusion — Balance impairment and cognitive impairment among newly admitted LTCH residents are associated with increased rate of disablement over the following two years. Further research should examine the mechanisms driving this association and identify whether they are amenable to intervention.