Table 19Physical function outcomes: U.S. longitudinal peer-reviewed studies

StudyMeasureResultRisk of Bias Rating
Oregon Assisted Living
Frytak et al., 200142
Functional ability, measured as need for assistance in ADLs, over 1 yearIntercept coefficient: -29.863, p=0.000
Slope coefficient: 0.656, p=0.465
The type of setting (AL vs. NH) was strongly related to functional ability at the start of the study, but it was not significantly related to individual growth rates.

Conclusions: AL and NH residents experienced change in physical functioning over the study period, but the change was not related to the type of setting they lived in, so there were no significant differences in the trajectory of physical functioning between AL and NH residents.
High
Pruchno and Rose, 200054Mean MAI functional ability over 1 year; higher score indicates better functionThere was a significant main effect for facility (AL versus NH) in the repeated ANOVA analysis, indicating that AL residents had higher mean functional scores across time compared with NH residents. The interaction term for time versus facility was not significant, indicating that there were not different trends over time in functional ability for AL versus NH residents.

Conclusions: Functional ability for AL and NH residents did not change at different rates.
High
Collaborative Studies of Long-Term Care subsample
aSloane et al, 200562
Mean increase in ADL dependency per 12 months; measure based on MDS ADL itemsResidents with mild dementia: AL 4.29, NH 5.80, p=0.059
Residents with moderate or severe dementia: AL 0.87, NH 1.13, p=0.807

Conclusions: Mean rates of decline in ADL dependency did not differ between AL and NH residents for the cohort with mild dementia or for the cohort with moderate or severe dementia.
High
Marek et al., 200548Mean impairment in ADLs; measured from MDS ADL items, with a range of 0–20, where higher scores indicate greater impairment6 months: HCBS mean 1.3, NH mean 3.2, p=0.02
12 months: HCBS mean 1.7, NH mean 3.5, p=0.04
18 months: HCBS mean 1.4, NH mean 3.8, p=0.08
24 months: HCBS mean 0.8, NH mean 3.2, p=0.00

Conclusions: ADL functioning was significantly better in the HCBS group compared with the NH group at all time periods except the 18-month time period.
High

ADL = Activities of Daily Living; AL = Assisted Living; ANOVA = Analysis of Variance; HCBS = Home and Community-Based Services; MAI = Multilevel Assessment Instrument; MDS = Minimum Data Set; NH = Nursing Home

Note: Table 16 reports analysis performed in each study.

Note: Table rows ordered by analyses of AL versus NH then by analyses of HCBS versus NH.

a

Study focused on samples with dementia.

From: Results

Cover of Long-Term Care for Older Adults
Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care [Internet].
Comparative Effectiveness Reviews, No. 81.
Wysocki A, Butler M, Kane RL, et al.

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