Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review

Objectives: To review the evidence on incidence and predictive factors of functional decline (FD) in nursing home (NH) residents. Design: A systematic review of the literature. Setting and Participants: Longitudinal studies involving individuals age 60 years and older living in a NH and with at least 2 functional capacity assessments were eligible. Methods: The search was carried out up to June 2021 and was conducted in Embase, PubMed, Web of Science, Cochrane Library, CINAHL, Scopus, SciELO, and Google Scholar databases. Results: A total of 27 studies met the eligibility criteria, most of which were prospective, recruiting participants in more than 1 NH, and conducted in a single country. Studies reported a high rate of functional dependency at baseline and FD at follow-up; in 1 year, 38.9% to 50.6% of residents experienced FD. Predictive factors of FD that were significant in at least 2 of the included studies were cognitive impairment, functional status at baseline, urinary incontinence, length of institutionalization, age, depression, being married, being male, and stroke disease. Protective factors were licensed nursing hours and presence of a geriatrician within the NH staff. Conclusions and Implications: This review highlights the high incidence of FD in NH residents and identifies risk and protective factors of FD that may support the design of preventative strategies for this vulnerable and frail population.