Dynamics of activities of daily living performance in institutionalized older adults: A two-year longitudinal study

Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study

Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.

Efficacy of therapeutic exercise on activities of daily living and cognitive function among older residents in long-term care facilities: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities.

DATA SOURCES

PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018.

STUDY SELECTION

Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes.

DATA EXTRACTION

Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer.

DATA SYNTHESIS

A total of 11 RCTs with 1,280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD] = 0. 22, 95% confidence interval [CI]: 0.02, 0.42, p = 0.03)]. Subgroup analyses indicated that interventions were conducted ≥ 3 days per week [SMD = 0.42, 95% CI 0.02, 0.82, p = 0.04]. For cognitive function, group exercise and ≥ 3 days/week of intervention had a significant benefit (group exercise: mean difference [MD] = 3.36, 95% CI 0.91, 5.80, p = 0.007; ≥ 3 days/week of intervention: MD = 2.28, 95% CI 0.07, 4.49, p = 0.04).

CONCLUSIONS

Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

Mobility Limitation in Older Adults Residing in Nursing Homes in Brazil Associated With Advanced Age and Poor Nutritional Status: An Observational Study

BACKGROUND AND PURPOSE

Mobility is a basic human need, and its limitation compromises health status, especially in older adults from developing countries and residing in nursing homes. This study aims to determine the prevalence and factors associated with mobility limitation in older adults residing in nursing homes.

METHODS

A cross-sectional study was conducted with 305 older adults (≥60 years) residing in 10 nursing homes in Northeast Brazil. Mobility limitation was evaluated using the "walking" item of the Barthel index. Sociodemographic/economic data concerning the participants and institutions, as well as conditions that could influence the mobility state of the older adults, were collected. The χ2 test and multiple logistic regression were performed using a significance level of 5%.

RESULTS AND DISCUSSION

The prevalence of mobility limitation was 65.6% (95% confidence interval [CI], 59.6-70.4). Walking dependence was identified in 39.7% of the sample (26.9% wheelchair users and 12.8% bedridden), while 25.9% walked with assistance (16.7% with maximal assistance and 9.2% with minimal assistance). Mobility limitation was significantly associated with malnutrition/risk of malnutrition (1.86, 95% CI, 1.54-2.26, P < .001) and age ≥81 years (1.35, 95% CI, 1.12-1.63, P = .002).

CONCLUSION

Mobility limitation has a high prevalence among older adults residing in nursing homes in Brazil, and is associated with advanced age and poor nutritional status. Health professionals should advocate for the maintenance of mobility and adequate nutritional support.

Replication of Implementing a Sit-to-Stand Exercise Program in an Assisted Living Facility

The current quality improvement project aimed at replicating the implementation of a sit-to-stand exercise program in a small 20-bed assisted living facility (ALF) in rural North Carolina. The primary outcome was for residents to maintain or improve function in performance of activities of daily living (ADLs). Even with the challenges of the coronavirus disease 2019 pandemic, ALF staff and residents found a way to continue the exercise program with a high level of participation and thus prevent avoidable decline in residents' independence with ADLs. [Journal of Gerontological Nursing, 48(3), 30-36.].

Physical performance trajectories and mortality among nursing home residents: results of the SENIOR cohort

BACKGROUND

Previous studies have shown that older people can experience a considerable change in their physical performance (PP) over time.

OBJECTIVES

To identify PP trajectories and their association with mortality among nursing home residents who were followed up for 3 years.

DESIGN

Three-year longitudinal observational study.

SETTING

Subjects of the SENIOR cohort.

SUBJECTS

Six hundred and four nursing home residents with a mean age of 82.9 ± 9.1 years.

METHODS

Baseline characteristics and the date of death were collected from the medical records. PP was assessed annually by the short physical performance battery (SPPB) test. Multiple imputations were performed to manage the missing data. PP trajectory groups were estimated using latent growth curve analysis. Cox proportional hazard regression models were applied to examine the risk of mortality according to the PP trajectory groups.

RESULTS

Three PP trajectory groups were identified: slow decline (N = 96), moderate decline (N = 234) and fast decline (N = 274). After adjustments for potential confounding variables and the baseline SPPB scores, the residents in the fast decline and moderate decline trajectory groups had an increased risk of mortality compared to those in the slow decline trajectory group, with hazard ratio values of 1.78 (95% confidence interval [CI] = 1.34-2.26) and 1.37 (95% CI = 1.10-1.66), respectively.

CONCLUSIONS

PP trajectories provide value-added information to baseline geriatric assessments and could be used for predicting 3-year mortality among nursing home residents. It may be important to regularly monitor the SPPB score and signal an alert when a fast decline in PP is detected in older people.

Nutritional Status Plays More Important Role in Determining Functional State in Older People Living in the Community than in Nursing Home Residents

The aim of this study was to verify whether the relationship between nutritional and functional status differs between seniors in the community and those in long-term care institutions. One hundred nursing home (NH) residents aged 60 years and above and 100 sex- and age-matched community-dwelling (CD) older adults were examined. Functional status was assessed using the Comprehensive Geriatric Assessment (CGA) and nutritional status using anthropometric measures, the Mini Nutritional Assessment questionnaire (MNA) and bioimpedance analysis (BIA). Significant environmental interactions were observed with resting metabolic rate (RMR), extracellular water (ECW) and intracellular water (ICW) ratio, skeletal muscle mass (SMM), skeletal muscle index (SMI) and impedance (Z) and resistance (R) to the results of the Timed Up and Go (TUG) test. The two groups demonstrated different relationships between Z and R and handgrip strength and between Geriatric Depression Scale (GDS) score and fat free mass (FFM), body density, total body water (TBW) and phase angle (PhA). Nutritional status seems to be more important for functional state in CD older people than in NH residents. Therefore, to ensure the functional independence of seniors living in the community, it is crucial to maintain the correct nutritional parameters. Further studies are necessary to account for the fact that this relationship is less significant among NH residents and to identify other factors that may contribute to these discrepancies between community and institutional environments.

What nursing home environment can maximise eating independence among residents with cognitive impairment? Findings from a secondary analysis

To explore the influence of the Nursing Home (NH) environment on eating independence while taking into account individual and nursing care factors, was the aim of the study. A secondary analysis was performed based on data collected in a multicentre prospective observational study involving 13 NHs. Residents aged >65 were included (n = 1,027). Dependence in eating was measured using the Edinburgh Feeding Evaluation in Dementia scale (EdFED, range 0-20). In addition to individual and nursing care variables, the NHs environments were assessed with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH, range 0-149). The mean EdFED score was 2.48 (95% Confidence Interval [CI]=2.22-2.73) and the TESS-NH score was 122.19 (95% CI=115.89-128.49). A linear regression analysis explained 30.8% of the total variance in eating dependence. Alongside individual and nursing care factors, in poor NH unit environments, residents with severe cognitive impairment showed increased eating dependence; in contrast, in better environments, similar residents showed maximal eating performance.

Functional decline in nursing home residents: A prognostic study

Aim

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.

Methods

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.

Results

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.

Conclusions

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.