Insufficient help for activity of daily living disabilities and risk of all-cause hospitalization

Huiping Xu, Kenneth E. Covinsky, Eric Stallard, Joseph Thomas, Laura P. Sands

Research output: Contribution to journalReview article

29 Scopus citations


Objectives To determine whether insufficient help for activity of daily living (ADL) disability, a potentially modifiable condition, significantly increases disabled older adults' risk of future hospital admissions. Design Prospective study. Setting Community-living participants with ADL disabilities in the 1994, 1999, and 2004 National Long-Term Care Survey (NLTCS). Participants Medicare recipients with one or more ADL disabilities completed 5,884 surveys. Measurements Times to hospital admission in the year after the NLTCS community survey were obtained from linked Medicare claims. Insufficient ADL help for each ADL limitation was determined from a series of questions common to the three NLTCS community surveys. Results Insufficient help for one or more ADL limitations was reported in 22% of surveys. Respondents to 3,629 surveys did not experience a hospital admission in the year after the survey. Of the remaining 2,255 surveys, one admission occurred for 382 surveys, two admissions for 525 surveys, three admissions for 193 surveys, and four or more admissions for 155 surveys. Participants reporting insufficient help were 14% (hazard ratio = 1.14, 95% confidence interval = 1.01-1.28) more likely to experience one or more hospitalizations than those who did not report insufficient help after controlling for demographic characteristics, comorbidities, prior hospitalizations, and level of ADL disability. Conclusion Self-reports of insufficient help provide prognostic information beyond what typical health assessments can capture. Greater recognition and referral for insufficient help for ADL disability may result in lower rates of hospitalization in a population that is at high risk of hospitalization.

Original languageEnglish (US)
Pages (from-to)927-933
Number of pages7
JournalJournal of the American Geriatrics Society
Issue number5
StatePublished - May 1 2012


  • activities of daily living
  • disability
  • hospitalization
  • insufficient help

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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