Prognostic factors for functional decline in institutionalized older people
Authors: Javier Jerez-Roig
Keywords: Activities of Daily. Living. Aged. Disabled Persons. Longitudinal Studies. Nursing Homes
Abstract : The objective was to estimate the probability of maintaining functional capacity in basic activities of daily living in institutionalized older adults. Besides, we aimed at identifying the prognostic factors of functional decline. A 2-year longitudinal study with 5 waves applied every 6 months was carried out. Individuals aged ≥60 in 10 nursing homes in the city of Natal-RN (Brazil) were included. 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 at baseline. Time dependent variables were 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. 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=1.98; p=0.003), continence decline (HR=1.70; p=0.013), and incidence of hospitalizations (HR=1.65; p=0.023), adjusted by Parkinson's disease, kidney failure, education level, reason for institutionalization ‘by own choice', tobacco consumption, marital status, private health plan, low weight, and incidence of depression. It can be concluded that the cumulative probability of maintaining functional capacity in this sample of Brazilian institutionalized older adults was only 44% at 2 years. Prognostic factors for functional decline were severe cognitive impairment at baseline, and continence decline and incidence of hospitalizations during the period.
05-05-2018
Javier Jerez-Roig
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| Citation: Javier Jerez-Roig. Prognostic factors for functional decline in institutionalized older people. https://doi.org/10.24175/sbd.2018.000044 |
| Received: May 05, 2018 Accepted: May 07, 2018 Published: May 07, 2018 |
| Copyright: © 2018 Javier Jerez-Roig. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC), which allows, distribution, reproduction in any medium, provided the original author and source are credited and non-commercial use. |
| Funding: I certify that no funding has been received for the conduct of this study and/or preparation of this manuscript. |
| Conflicts of Interest: I have no conflicts of interest to declare |
Prognostic factors for functional decline in institutionalized older people
Javier Jerez-Roig, Ph.D1,2,3, Lidiane Maria de Brito Macedo Ferreira, Ph.D4, José Rodolfo Torres de Araújo, M.D. 5 and Kenio Costa Lima, Ph.D3
1Methodology, Methods, Models and Health and Social Outcomes research group, University of Vic – Central University of Catalonia, C. Sagrada Família, 7, 08500 Vic, Spain
2Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022 Barcelona, Spain
3Postgraduate Program in Collective Health, Odontology Department, Federal University of Rio Grande do Norte (UFRN), Avenida Salgado Filho 1787, 59010-000, Lagoa Nova, Natal-RN, Brazil.
4Departamento de Cirurgia, Hospital Universitário Onofre Lopes, UFRN, Av. Nilo Peçanha, 620, 59012-300, Petrópolis, Natal - RN, Brazil
5Postgraduate Program in Health Sciences, Center of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Av. Gustavo Cordeiro de Farias, s/n, Petrópolis, Natal RN, CEP 59.012-570, Natal-RN, Brazil
Key words: Activities of Daily. Living. Aged. Disabled Persons. Longitudinal Studies. Nursing Homes.
The objective was to estimate the probability of maintaining functional capacity in basic activities of daily living in institutionalized older adults. Besides, we aimed at identifying the prognostic factors of functional decline. A 2-year longitudinal study with 5 waves applied every 6 months was carried out. Individuals aged ≥60 in 10 nursing homes in the city of Natal-RN (Brazil) were included. 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 at baseline. Time dependent variables were 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. 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=1.98; p=0.003), continence decline (HR=1.70; p=0.013), and incidence of hospitalizations (HR=1.65; p=0.023), adjusted by Parkinson's disease, kidney failure, education level, reason for institutionalization 'by own choice', tobacco consumption, marital status, private health plan, low weight, and incidence of depression. It can be concluded that the cumulative probability of maintaining functional capacity in this sample of Brazilian institutionalized older adults was only 44% at 2 years. Prognostic factors for functional decline were severe cognitive impairment at baseline, and continence decline and incidence of hospitalizations during the period.
