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J Gerontol A Biol Sci Med Sci. 2019 Dec 20. pii: glz296. doi: 10.1093/gerona/glz296. [Epub ahead of print]

Predictors of functional decline in nursing home residents: the Shelter project.

Author information

1
Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy.
2
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy e Università Cattolica del Sacro Cuore, Rome, Italy.
3
Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy.
4
Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy.
5
Unit of Geriatric Pharmacoepidemiology and Clinical Laboratory, IRCCS INRCA, Cosenza, Italy.
6
Medical Direction, IRCCS INRCA, Ancona, Italy.
7
Scientific Direction, IRCCS INRCA, Ancona, Italy.

Abstract

BACKGROUND:

The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics.

METHODS:

longitudinal observational study involving 1760 older (≥ 65 years) residents of NH participating in the SHELTER* study (57 NH in 8 countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a one year follow-up. Facility and country effect were taken into account.

RESULTS:

During the study period 891 (50,6%) NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence and used more antipsychotics. In the mixed effect logistic regression model factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor.

CONCLUSION:

Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents' care might be an important strategy to improve the outcome of this vulnerable population.

KEYWORDS:

Nursing home; dementia; functional decline; geriatrician

PMID:
31858108
DOI:
10.1093/gerona/glz296

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