Longitudinal changes in functional capacity among surviving old people continuously resident in hospitals and homes

A group of surviving, continuously resident elderly people was identified through linkage of data from two cross sectional studies (three years apart) of all types of hospital and homes provided within a defined geographical area. Although 60-70% were unchanged in their ability to perform basic activities of daily living, any change was most often deterioration: between three and four to one. The exception was for faecal incontinence: a higher proportion remained unchanged but of those who changed, more deteriorated than was so for other activities. Change was greater when all aspects of functional capacity were considered, though the extent of deterioration was similar. Greater change and greater deterioration were associated with increasing age, the male sex, shorter initial duration of stay, and residence in a geriatric ward. After adjustment for differences in such factors, patients in geriatric and psychiatric wards deteriorated to a similar extent but significantly more than residents of homes for the elderly. Few such data are available, yet they are necessary for assessing the impact of different institutional regimens and formulating rehabilitation strategies.