The association between activity participation and time to discharge in the assisted living setting

Objectives: Given recent evidence that activity participation may reduce functional decline, the effect of activity on resident ability to remain in assisted living (AL) is of interest. This study examines the relationship between participation in activities and the length of time residents remain in AL. Methods: The data reported here were gathered in the initial phase of the Maryland Assisted Living Study (MDAL), an epidemiologic study of psychiatric disorders in AL. A stratified, random sample of 198 residents of 22 AL facilities in central Maryland was evaluated using a number of cognitive, behavioral, general health, and functional assessments. The total amount of time each resident spent in group and solitary activity in the prior month was quantified. The dependent variable, time to discharge (TrD), was the number of days between the date of initial assessment by the study team and the date of death in AL, discharge, or administrative censoring. Results: Greater levels of activity participation at baseline are associated with longer TrD in an univariate Cox proportional hazards model. After adjustment for global cognitive functioning, general medical health, and mobility, greater activity participation remained associated with longer TrD in AL (p=0.017). Conclusions: Higher levels of activity are associated with longer retention in the AL setting. This effect appeared to be independent of other potentially confounding factors such as general health, cognitive impairment, and mobility. This finding is consistent with the hypothesis that engagement in activities delays functional decline, but further longitudinal research is needed to understand this finding.