Functional decline in nursing home residents: A prognostic study

• Published in: PloS one 2017-05, Vol.12 (5), p.e0177353-e0177353
• Main Authors: Jerez-Roig, Javier, de Brito Macedo Ferreira, Lidiane Maria, Torres de Araújo, José Rodolfo, Costa Lima, Kenio
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adaptation; Adults; Aged; Aged, 80 and over; Aging; Analysis; Antiinfectives and antibacterials; Arches; Autonomy; Bathing; Biology and Life Sciences; Care and treatment; Chronic diseases; Chronic illnesses; Classification; Cognitive ability; Coma; Comminution; Complications; Computer and Information Sciences; Death; Dependent variables; Developing countries; Disabilities; Disability; Disorders; Drugs; Elderly; Epidemiology; Evaluation; Exposure; Eye; Fecundity; Female; Fractures; Geriatrics; Health aspects; Health sciences; Humans; Hygiene; Immobilization; Incidence; Independent variables; Institutionalization; Institutionalization - statistics & numerical data; Institutions; LDCs; Life span; Literature reviews; Long term health care; Longitudinal studies; Male; Management; Mathematical analysis; Medical personnel; Medical prognosis; Medicine and Health Sciences; Minerals; Models, Theoretical; Nursing homes; Nursing Homes - statistics & numerical data; Odontology; Older people; People and Places; Personal hygiene; Probability; Prognosis; Public health; Quality of life; Rankings; Research and Analysis Methods; Risk factors; Social Sciences; Statistical analysis; Statistical methods; Stroke; Studies; Survival Rate; Variables; Vigilance; Vitamins; World Wide Web
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0177353

To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults. A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013-2015), conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil). Functional capacity was assessed by the items 'eating', 'personal hygiene', 'dressing', 'bathing', 'transferring', 'toileting' and 'walking', through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Cox's regression were applied as statistical methods. The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8-82.7%), 65.1% (CI 95%: 58.9-70.5%), 53.5% (CI 95%: 47.2-59.5%) and 44.0% (CI 95%: 37.7-50.2%) at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001), continence decline (HR = 1.85; p = 0.002) and incidence of hospitalizations (HR = 1.62; p = 0.020), adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight. The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.