Advertisement

Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review

  • Pau Moreno-Martin
    Affiliations
    Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
    Search for articles by this author
  • Javier Jerez-Roig
    Correspondence
    Address correspondence to Javier Jerez-Roig, PhD, Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, 08500 Vic, Spain.
    Affiliations
    Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
    Search for articles by this author
  • Sandra Rierola-Fochs
    Affiliations
    Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
    Search for articles by this author
  • Vinicius Rosa Oliveira
    Affiliations
    Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
    Search for articles by this author
  • Pau Farrés-Godayol
    Affiliations
    Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
    Search for articles by this author
  • Dyego Leandro Bezerra de Souza
    Affiliations
    Department of Collective Health, Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
    Search for articles by this author
  • Maria Giné-Garriga
    Affiliations
    Faculty of Health Sciences Blanquerna, Ramon Llull University, Barcelona, Spain

    Faculty of Psychology, Education and Sport Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
    Search for articles by this author
  • Joanne Booth
    Affiliations
    Research Center for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
    Search for articles by this author
  • Dawn A. Skelton
    Affiliations
    Research Center for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
    Search for articles by this author
  • Eduard Minobes-Molina
    Affiliations
    Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
    Search for articles by this author

      Abstract

      Objectives

      To review the evidence on incidence and predictive factors of functional decline (FD) in nursing home (NH) residents.

      Design

      A systematic review of the literature.

      Setting and Participants

      Longitudinal studies involving individuals age 60 years and older living in a NH and with at least 2 functional capacity assessments were eligible.

      Methods

      The search was carried out up to June 2021 and was conducted in Embase, PubMed, Web of Science, Cochrane Library, CINAHL, Scopus, SciELO, and Google Scholar databases.

      Results

      A total of 27 studies met the eligibility criteria, most of which were prospective, recruiting participants in more than 1 NH, and conducted in a single country. Studies reported a high rate of functional dependency at baseline and FD at follow-up; in 1 year, 38.9% to 50.6% of residents experienced FD. Predictive factors of FD that were significant in at least 2 of the included studies were cognitive impairment, functional status at baseline, urinary incontinence, length of institutionalization, age, depression, being married, being male, and stroke disease. Protective factors were licensed nursing hours and presence of a geriatrician within the NH staff.

      Conclusions and Implications

      This review highlights the high incidence of FD in NH residents and identifies risk and protective factors of FD that may support the design of preventative strategies for this vulnerable and frail population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Ageing and health.
        • Kirkwood T.B.L.
        A systematic look at an old problem.
        Nature. 2008; 451: 644-647
      2. World report on Ageing And HeAltH.
        www.who.int
        Date: 2015
        Date accessed: November 18, 2021
        • Ansah J.P.
        • Chiu C.T.
        • Wei-Yan A.C.
        • Min T.L.S.
        • Matchar D.B.
        Trends in functional disability and cognitive impairment among the older adult in China up to 2060: estimates from a dynamic multi-state population model.
        BMC Geriatr. 2021; 21: 380
        • Berlau D.J.
        • Corrada M.M.
        • Kawas C.
        The prevalence of disability in the oldest-old is high and continues to increase with age: findings from The 90+ Study.
        Int J Geriatr Psychiatry. 2009; 24: 1217-1225
        • Jacobs J.M.
        • Maaravi Y.
        • Cohen A.
        • Bursztyn M.
        • Ein-Mor E.
        • Stessman J.
        Changing profile of health and function from age 70 to 85 years.
        Gerontology. 2012; 58: 313-321
        • Palese A.
        • Menegazzi G.
        • Tullio A.
        • Zigotti Fuso M.
        • Hayter M.
        • Watson R.
        Functional decline in residents living in nursing homes: a systematic review of the literature.
        J Am Med Dir Assoc. 2016; 17: 694-705
        • Katz P.R.
        An international perspective on long term care: focus on nursing homes.
        J Am Med Dir Assoc. 2011; 12: 487-492.e1
        • Gordon A.L.
        • Franklin M.
        • Bradshaw L.
        • Logan P.
        • Elliott R.
        • Gladman J.R.F.
        Health status of UK care home residents: a cohort study.
        Age Ageing. 2014; 43: 97
        • Raîche M.
        • Hébert R.
        • Dubois M.F.F.
        • Gueye N.R.N.R.
        • Dubuc N.
        Yearly transitions of disability profiles in older people living at home.
        Arch Gerontol Geriatr. 2012; 55: 399-405
        • de Meijer C.
        • Koopmanschap M.
        • d'Uva T.B.
        • van Doorslaer E.
        Determinants of long-term care spending: age, time to death or disability?.
        J Health Economics. 2011; 30: 425-438
        • Martin F.C.
        • Romero Ortuño R.
        Longitudinal studies of ageing: from insights to impacts: commentary to accompany themed collection on longitudinal studies.
        Age Ageing. 2019; 48: 482-485
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
      3. Study Quality Assessment Tools, NHLBI, NIH.
        • Bliesmer M.M.
        • Smayling M.
        • Kane R.L.
        • Shannon I.
        The relationship between nursing staffing levels and nursing home outcomes.
        J AgingHealth. 1998; 10: 351-371
        • Büla C.J.
        • Ghilardi G.
        • Wietlisbach V.
        • Petignat C.
        • Francioli P.
        Infections and functional impairment in nursing home residents: a reciprocal relationship.
        J Am Geriatr Soc. 2004; 52: 700-706
        • Bürge E.
        • von Gunten A.
        • Berchtold A.
        Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: a survival analysis.
        Arch Gerontol Geriatr. 2013; 56: 250-257
        • Chen L.Y.
        • Liu L.K.
        • Liu C.L.
        • et al.
        Predicting functional decline of older men living in Veteran homes by Minimum Data Set: implications for disability prevention programs in long-term care settings.
        J Am Med Dir Assoc. 2013; 14: 309.e9-309.e13
        • Chen L.Y.
        • Liu L.K.
        • Hwang A.C.
        • et al.
        Impact of malnutrition on physical, cognitive function and mortality among older men living in veteran homes by minimum data set: a prospective cohort study in Taiwan.
        J Nutr Health Aging. 2016; 20: 41-47
        • Contreras-Escámez B.
        • Izquierdo M.
        • Galbete Jiménez A.
        • Gutiérrez-Valencia M.
        • Cedeno-Veloz B.A.
        • Martínez-Velilla N.
        Differences in the predictive capability for functional impairment, cognitive decline and mortality of different frailty tools: a longitudinal cohort study.
        Medicina Clinica. 2020; 155: 18-22
        • de La Rica-Escuín M.
        • González-Vaca J.
        • Varela-Pérez R.
        • et al.
        Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.
        Maturitas. 2014; 78: 329-334
        • Diekmann R.
        • Winning K.
        • Bauer J.M.
        • et al.
        Vitamin-D-status und körperliche funktionalität bei pflegeheimbewohnern: eine 1-jahres-beobachtungsstudie.
        Zeitschrift fur Gerontologie und Geriatrie. 2013; 46: 403-409
        • Dosa D.
        • Feng Z.
        • Hyer K.
        • Brown L.M.
        • Thomas K.
        • Mor V.
        Effects of Hurricane Katrina on nursing facility resident mortality, hospitalization, and functional decline.
        Disaster Med Public Health Preparedness. 2010; 4: S28-S32
        • Fedecostante M.
        • Dell'Aquila G.
        • Eusebi P.
        • et al.
        Predictors of functional changes in Italian nursing home residents: the U.L.I.S.S.E. study.
        J Am Med Dir Assoc. 2016; 17: 306-311
        • Fedecostante M.
        • Onder G.
        • Eusebi P.
        • et al.
        Predictors of functional decline in nursing home residents: the shelter project.
        J Gerontol Ser A Biol Sci Med Sci. 2020; 75: 1600-1605
        • Jerez-Roig J.
        • de Brito MacEdo Ferreira L.M.
        • de Araújo J.R.T.
        • Lima K.C.
        Functional decline in nursing home residents: a prognostic study.
        PLoS ONE. 2017; 12: 1-14
        • Kuo H.T.
        • Lin K.C.
        • Lan C.F.
        • Li I.C.
        Activities of daily living trajectories among institutionalised older adults: a prospective study.
        J Clin Nurs. 2017; 26: 4756-4767
        • Lane N.E.
        • Stukel T.A.
        • Boyd C.M.
        • Wodchis W.P.
        Long-term care residents' geriatric syndromes at admission and disablement over time: an observational cohort study.
        J Gerontol Ser A Biol Sci Med Sci. 2019; 74: 917-923
        • Luo H.
        • Tang J.Y.M.
        • Wong G.H.Y.
        • et al.
        The effect of depressive symptoms and antidepressant use on subsequent physical decline and number of hospitalizations in nursing home residents: a 9-year longitudinal study.
        J Am Med Dir Assoc. 2015; 16: 1048-1054
        • Masciocchi E.
        • Maltais M.
        • El Haddad K.
        • et al.
        Defining vitality using physical and mental well-being measures in nursing homes: a prospective study.
        J Nutr Health Aging. 2020; 24: 37-42
        • McConnell E.S.
        • Pieper C.F.
        • Sloane R.J.
        • Branch L.G.
        Effects of cognitive performance on change in physical function in long-stay nursing home residents.
        J Gerontol Ser A Biol Sci Med Sci. 2002; 57: M778-M784
        • Palese A.
        • Grassetti L.
        • Zuttion R.
        • et al.
        Self-feeding dependence incidence and predictors among nursing home residents: findings from a 5 year retrospective regional study.
        Nurs Health Sci. 2019; 21: 297-306
        • Pizzato S.
        • Sergi G.
        • Bolzetta F.
        • et al.
        Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up.
        Eur J Clin Nutr. 2015; 69: 1113-1118
        • Porell F.
        • Caro F.G.
        Facility-level outcome performance measures for nursing homes.
        The Gerontologist. 1998; 38: 665-683
        • Talley K.M.C.
        • Wyman J.F.
        • Savik K.
        • Kane R.L.
        • Mueller C.
        • Zhao H.
        Restorative care's effect on activities of daily living dependency in long-stay nursing home residents.
        Gerontologist. 2015; 55: S88-S98
        • Wang J.
        • Kane R.L.
        • Eberly L.E.
        • Virnig B.A.
        • Chang L.H.
        The effects of resident and nursing home characteristics on activities of daily living.
        J Gerontol Ser A Biol Sci Med Sci. 2009; 64: 473-480
        • Wang J.
        • Chang L.H.
        • Eberly L.E.
        • Virnig B.A.
        • Kane R.L.
        Cognition moderates the relationship between facility characteristics, personal impairments, and nursing home residents' activities of daily living.
        J Am Geriatr Soc. 2010; 58: 2275-2283
        • Watfa G.
        • Benetos A.
        • Kearney-Schwartz A.
        • et al.
        Do arterial hemodynamic parameters predict cognitive decline over a period of 2 years in individuals older than 80 years living in nursing homes? The PARTAGE study.
        J Am Med Dir Assoc. 2015; 16: 598-602
        • Yeh S.C.J.
        • Lo S.K.
        Is rehabilitation associated with change in functional status among nursing home residents?.
        J Nurs Care Qual. 2004; 19: 58-66
        • Yeh K.P.
        • Lin M.H.
        • Liu L.K.
        • Chen L.Y.
        • Peng L.N.
        • Chen L.K.
        Functional decline and mortality in long-term care settings: static and dynamic approach.
        J Clin Gerontol Geriatr. 2014; 5: 13-17
        • Zuliani G.
        • Romagnoni F.
        • Volpato S.
        • et al.
        Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes.
        J Gerontol Ser A Biol Sci Med Sci. 2001; 56: M212-M216
        • García-Hermoso A.
        • Ramirez-Vélez R.
        • Sáez de Asteasu M.L.
        • et al.
        Safety and effectiveness of long-term exercise interventions in older adults: a systematic review and meta-analysis of randomized controlled trials.
        Sports Med (Auckland, NZ). 2020; 50: 1095-1106
        • Merchant R.A.
        • Morley J.E.
        • Izquierdo M.
        Exercise, aging and frailty: guidelines for increasing function.
        J Nutr Health Aging. 2021; 25: 405-409
        • Fink H.A.
        • Taylor B.C.
        • Tacklind J.W.
        • Rutks I.R.
        • Wilt T.J.
        Treatment Interventions in nursing home residents with urinary incontinence: a systematic review of randomized trials.
        Mayo Clin Proc. 2008; 83: 1332-1343
        • Hartigan I.
        A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people.
        Int J Older People Nurs. 2007; 2: 204-212