Functional decline of the elderly in a nursing home

This study aims to determine if risk factors present on admission to the nursing home could be predictive of later functional decline and to determine the causes of decline.

This is a retrospective case-control study conducted in 2000 at a voluntary welfare nursing home. Functional decline was defined as deterioration in two or more of the five activities of daily living (ADLs), namely: mobility, toileting, bathing, dressing and feeding, from the time of admission to the study period. Potential risk factors for decline studied were: age, sex, marital status, number of medical diagnoses and medications, types of medical diagnoses, and the presence of dementia on admission to the home. Causes of decline were categorised as (A) Development of new illness, (B) Progression of chronic illness, or (C) Both of the above.

36 out of 103 residents had functional decline. On analysis, univariate and multivariable logistic regression models, adjusted for length of stay, yielded the same significant risk factors for decline, namely: age (p-value is 0.02) and dementia (p-value is 0.04). Majority of decline (78 percent) was due to progression of chronic illnesses, most commonly dementia (15 out of 36), eight percent were due to acute illness (stroke), and 14 percent were due to both. In January 2003, 18 out of the 36 residents who declined had died.

Functional decline is common in the nursing home. More attention should be paid to the older residents and those with dementia, right from the point of admission.