title: Functional Decline in Residents Living in Nursing Homes: A Systematic Review of the Literature.
abstract: To describe the functional dependence progression over time in older people living in nursing homes (NHs).
  
  
  
  A systematic review of the literature was performed. Studies involving individuals 65 years and older living in NHs, describing their functional decline, improvement or stability in activities of daily living (ADLs), were eligible. The search strategy was applied in MedLine, Cochrane, CINAHL, and SCOPUS databases; aimed at identifying an unbiased and complete list of studies, searching by hand was also performed. The methodological quality of the 27 studies included was assessed.
  
  
  
  Functional trajectories were documented mainly through multicenter study design including sample size ranging from 2 to 9336 NHs, from 1983 to 2011 throughout a single or multiple follow-ups (>20). The average rate of decline was expressed in different metrics and periods of time: from 3 months with a decline of -0.13 points of 28, to 6 months (-1.78 points of 2829) to 1.85 years (-0.5 points of 6). Eating and toileting were the most documented ADLs and the decline is approximately 0.4 points and 0.2 to 0.4 points of 5 a year, respectively. Among the covariates, individual factors, such as cognitive status, were mainly considered, whereas only 13 studies considered facility-level factors.
  
  
  
  Findings report the slow functional decline mainly in women living in US NHs, in years when residents were admitted with a low or medium degree of functional dependence. Considering that in recent years residents have been admitted to NHs with higher-level functional dependence, studies measuring each single ADL, using standardized instruments capable of capturing the signs of decline, stability, or improvement are strongly recommended. Among the covariates, evaluation of both individual and facility-level factors, which may affect functional decline, is also suggested.
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy. Electronic address: alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.affiliation: Epidemiology and Public Health Unit, University of Udine, Udine, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Menegazzi
authors.affiliation: Epidemiology and Public Health Unit, University of Udine, Udine, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Tullio
authors.affiliation: Epidemiology and Public Health Unit, University of Udine, Udine, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Zigotti Fuso
authors.affiliation: Faculty of Health & Social Care, University of Hull, Hull, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Hayter
authors.affiliation: Faculty of Health & Social Care, University of Hull, Hull, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Watson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010809:Physical Fitness / Q000502:physiology*
keywords: Activities of daily living; functional decline; instruments; nursing homes; systematic review