People receiving skilled nursing care have multiple comorbid conditions that impact comfort and resource utilization. This longitudinal study describes variations in the trajectories of new physical problems emerging over 8 weeks and the predictive value for future health and behavior in residents from two nursing homes with dementia. The sample of 72 had 668 new physical problems with a range of 2 to 37 occurring over eight weeks. Sixty-five percent of the sample (n = 47) had 5 or more new problems and were identified by three unstable trajectories. Thirty-nine percent (n = 28) had a spike in new problems of 4 or more in one week. Spikes, new physical problems, and the problem-free duration predicted 23.6% of the variance in both new physical problems and new agitation occurring in the subsequent month (p < .001). Common problems, acute illness, and symptoms accounted for 28.2% of the variance in subsequent new physical problems (p < .001) and 25.7% of the variance in subsequent agitation (p < .001). The frequency of new problems and differences in the patterns of how these problems emerged over a relatively short time period suggests instability and variability in physiologic health that has not been previously identified. The possible existence of different pathways of decline may have important implications for health care delivery. Findings suggest a higher intensity of need for skilled assessment and treatment than may be available in many long-term care organizations.
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