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Functional transitions among the elderly: patterns, predictors, and related hospital use.

V Mor, V Wilcox, W Rakowski and J Hiris

Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912.

OBJECTIVES. This paper describes 6-year rates and correlates of functional change in the elderly, as well as associated hospital use. METHODS. The Longitudinal Study on Aging (n = 7527) and matched Medicare claims were used to calculate 6-year functional status transition rates and hospital use rates. A hierarchical measure that incorporated activities of daily living, instrumental activities of daily living, and competing risks of institutionalization and death was used to assess functional status. Multinomial logistic regression was used to predict 1990 status. RESULTS. The functional status of 12% of men and women 70 to 79 years of age who were initially impaired in instrumental activities of daily living improved, and about half of the initially independent people in that age group remained so. Multivariate analyses revealed that age, baseline functioning, self-rated health, and comorbidity predicted 1990 status. Both baseline functioning and functional change were related to hospitalization. CONCLUSIONS. This study supports others that have shown some long-term functional improvement, but more commonly decline, in the elderly. Furthermore, it documents the link between functional decline and increased hospital use.

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