title: Predictors of Functional Changes in Italian Nursing Home Residents: The U.L.I.S.S.E. Study.
abstract: OBJECTIVE
  To identify independent predictors of the risk of functional decline in older nursing home (NH) residents.
  
  
  METHODS
  A longitudinal observational study.
  
  
  METHODS
  Thirty-one NHs participating in the U.L.I.S.S.E. project, distributed throughout Italy.
  
  
  METHODS
  All older (≥65 years) long-term NH residents without complete disability and with at least one follow-up evaluation during the 12-month study period (n = 1263).
  
  
  METHODS
  All participants underwent a standardized comprehensive evaluation using the Italian version of the Minimum Data Set for NHs. The activities of daily living (ADLs) Long-Form scale was used to evaluate functional status. Facility characteristics were collected using an ad hoc designed questionnaire.
  
  
  RESULTS
  Of the NH residents, 40.4% experienced a decline in the ADL during the follow-up. The mixed effect logistic regression model showed that depression (odds ratio [OR] 1.45, confidence interval [CI] 1.16-1.81, P = .005) and the use of antipsychotics (OR 1.30, CI 1.06-1.60, P = .016) were associated with a higher probability of ADL decline, whereas the presence of a geriatrician (OR 0.60, CI 0.41-0.88, P = .015) and a higher than median hour per resident per week of nursing care (OR 0.55, CI 0.37-0.80, P = .006) were associated with a lower risk.
  
  
  CONCLUSIONS
  Our findings suggest that preventing functional decline in NH residents might be possible by optimizing the management of depression and by reducing the current high prescription rate of antipsychotics. Moreover, the presence of a geriatrician, associated with an adequate amount of nursing care, seem to be important facilities characteristics to achieve this goal. These findings should be tested in large-scale pragmatic clinical trials.
authors.affiliation: Department of Medicine, Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fedecostante
authors.affiliation: Department of Medicine, Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Dell'Aquila
authors.affiliation: Epidemiology Department, Regional Health Authority of Umbria, Perugia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Eusebi
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology, and Clinical Nutrition, University of Ferrara, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology, and Clinical Nutrition, University of Ferrara, Ferrara, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zuliani
authors.affiliation: Dipartimento di Scienze Mediche Traslazionali, Università di Napoli "Federico II", Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Abete
authors.affiliation: Scientific Direction, IRCCS-INRCA, Ancona, Italy.
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
authors.affiliation: Department of Medicine, Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy. Electronic address: a.cherubini@inrca.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cherubini
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes; D011237:Predictive Value of Tests; D011795:Surveys and Questionnaires
keywords: Nursing home; antipsychotics; depression; functional decline; geriatrician; nurse