Sepsis Survivors Admitted to Skilled Nursing Facilities: Cognitive Impairment, Activities of Daily Living Dependence, and Survival

TitleSepsis Survivors Admitted to Skilled Nursing Facilities: Cognitive Impairment, Activities of Daily Living Dependence, and Survival
Publication TypeJournal Article
Year of Publication2018
AuthorsEhlenbach W.J, Gilmore-Bykovskyi A., Repplinger M.D, Westergaard R.P, Jacobs E.A, Kind A.JH, Smith M.
JournalCrit Care Med
Volume46
Issue1
Pagination37-44
Date PublishedJan
ISBN Number0090-3493
Accession Number28991827
Keywords*Patient Admission, *Skilled Nursing Facilities, *Survivors, Activities of Daily Living/*classification, Aged, Aged, 80 and over, Cognitive Dysfunction/*mortality/*nursing, Cohort Studies, Comorbidity, Female, Humans, Kaplan-Meier Estimate, Male, Proportional Hazards Models, Retrospective Studies, Risk Factors, Sepsis/*mortality, Statistics as Topic, Survival Analysis, Wisconsin
Abstract

OBJECTIVE: Severe sepsis survivors frequently experience cognitive and physical functional impairment. The degree of impairment and its association with mortality is understudied, particularly among those discharged to a skilled nursing facility. Our objective was to quantify the cognitive and physical impairment among severe sepsis survivors discharged to a skilled nursing facility and to investigate the relationship between impairment and long-term mortality. DESIGN: Retrospective cohort study. SETTING: United States. SUBJECTS: Random 5% sample of Medicare patients discharged following severe sepsis hospitalization, 2005-2009 (n = 135,370). MEASUREMENT AND MAIN RESULTS: Medicare data were linked with the Minimum Data Set; Minimum Data Set-Cognition Scale was used to assess cognitive function, and the Minimum Data Set activities of daily living hierarchical scale was used to assess functional dependence. Associations were evaluated using multivariable logistic regression, Kaplan-Meier curves, and Cox proportional hazards regression. Of 66,540 beneficiaries admitted to a skilled nursing facility following severe sepsis, 34% had severe or very severe cognitive impairment, and 72.5% had maximal, dependence, or total dependence in activities of daily living. Median survival was 19.4 months for those discharged to a skilled nursing facility without having been in a skilled nursing facility in the preceding 1 year and 10.4 months for those discharged to a skilled nursing facility who had spent time in a skilled nursing facility in the prior year. The adjusted hazard ratio for death was 3.1 for those with very severe cognitive impairment relative to those who were cognitively intact (95% CI, 2.9-3.2; p < 0.001) and 4.3 for those with "total dependence" in activities of daily livings relative to those who were independent (95% CI, 3.8-5.0; p < 0.001). CONCLUSIONS: Discharge to a skilled nursing facility following severe sepsis hospitalization among Medicare beneficiaries was associated with shorter survival, and cognitive impairment and activities of daily living dependence were each strongly associated with shortened survival. These findings can inform decision-making by patients and physicians and underscores high palliative care needs among sepsis survivors discharged to skilled nursing facility.

URLhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858875/pdf/nihms904720.pdf
DOI10.1097/ccm.0000000000002755
PMCID

PMC5858875

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Short TitleCritical care medicineCritical care medicine
Alternate JournalCritical care medicine