title: The influence of cognitive impairment and psychiatric symptoms on daily functioning in nursing facilities: a longitudinal study.
abstract: The influence of psychiatric symptoms and cognitive status on daily living skills was explored among persons with dementia residing in skilled nursing facilities. Psychiatric symptoms were examined in three domains: 1) depression, 2) psychosis, and 3) behavioral disturbances. Twenty-eight subjects were followed for a 1-year duration in rural nursing facilities. The relationship between psychiatric symptoms, cognition, and daily living skills was assessed using correlation and regression analyses. Over a one-year period, cognitive and functional impairment progressed significantly. In contrast, psychiatric symptoms across all three domains did not necessarily persist or increase. Deterioration in cognitive function was significantly correlated with reduced functional status both cross-sectionally and longitudinally. Among psychiatric symptoms, only behavioral disturbances were significantly associated with functional impairment cross-sectionally. Cognitive decline and loss of social functioning may constitute the greatest source of disability among persons in nursing facilities. Furthermore, both impairments increase over time in contrast to psychiatric symptoms, which appear to have a more variable course. These findings may have implications for treatment interventions that seek to enhance functioning in the skilled nursing setting.
authors.affiliation: Department of Psychiatry, University of Iowa College of Medicine, 500 Newton Road, Iowa City, Iowa 52242-1000, USA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Schultz
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Ellingrod
authors.forename: David J
authors.initials: DJ
authors.lastname: Moser
authors.forename: Eric
authors.initials: E
authors.lastname: Kutschner
authors.forename: Carolyn
authors.initials: C
authors.lastname: Turvey
authors.forename: Stephan
authors.initials: S
authors.lastname: Arndt
mesh_terms: D000203:Activities of Daily Living / Q000145:classification* / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000451:nursing / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000451:nursing / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000451:nursing / Q000523:psychology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D007484:Iowa; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D009735:Nursing Homes; D011594:Psychometrics; D011618:Psychotic Disorders / Q000175:diagnosis / Q000451:nursing / Q000523:psychology; D015203:Reproducibility of Results; D012307:Risk Factors; D012424:Rural Population; D012920:Social Behavior Disorders / Q000175:diagnosis / Q000451:nursing / Q000523:psychology