Physical Functional Status in Nursing Home Patients Must Be Monitored Regularly by Nursing Staff

Among the 1.4 million older adults in the United States who receive long term care in nursing home facilities, the prevalence of functional limitations is high.  According to an article recently published in the Journal of American Medical Directors Association, the number of people with functional limitations is predicted to increase by about 120% worldwide, with those under the care of an institution rising by an estimated 130%.  Functional decline is well known to be a strong indicator of long-term institutionalization and its regular evaluation after nursing home admission is deemed a primary measure indicating the quality of care provided.  Not much is known about the functional status trajectory of older adults living in nursing home facilities where the facility environment, as well as individual factors, could exacerbate, accelerate, or lessen the decline based on the nursing care, rehabilitation, and medical services provided.

Physical functional level is defined as the level of basic activities of daily living performed by a person to meet the needs of the individual in various dimensions of life (i.e., physical, cognitive, social, psychological, and spiritual).  The process of functional decline follows a trajectory: early-loss activities of daily living (dressing and personal hygiene) are the first to decline, then middle-loss activities of daily living (toileting, transferring and locomotion), and finally late-loss activities of daily living (bed mobility and eating).  Common risk factors of functional decline include old age, gender, nationality, chronic illnesses, cognitive impairment, inadequate nutrition, poor social support, and nursing home facility-level factors. Not surprisingly, the consequences of loss of physical functioning have been reported as worse quality of life and physical health, recurring hospital admission, and an increased rate of mortality.

An increasing number of elderly patients are being admitted into a nursing home in much worse condition than in the past.  Research shows that older adult patients admitted to nursing homes are coming in sicker and closer to death than their community-dwelling counterparts; only an estimated 10% of newly admitted nursing home patients require very little assistance in activities of daily living tasks.  Moreover, nursing home staff are increasingly lacking in knowledge about physical functional decline.  Meanwhile, rapid loss of functioning in the past three months of life is already efficiently documented.  It is highly critical that nursing staff continuously update the data on functional changes in nursing home patients, due to its significant effect on numerous aspects of care, including staffing levels, staff training, care delivery models, and preventive interventions aimed to address specific impairments and groups of at-risk patients.

The article discusses a recent study that examined the dependence progression over time in elderly patients residing in nursing home facilities.  The study explored current evidence-based literature and found that women residing in nursing homes in the United States were the most vulnerable to slow functional decline, in years when patients were admitted with a mild or moderate level of functional dependence.  It is important that nursing home staff continue to monitor their residents’ physical functional status and provide the necessary care they need in order to maintain their quality of life and wellbeing as much as possible. Nursing homes, such as those in Oakland and San Leandro, California, that fail to oversee their patients’ functional status on a regular basis, increase their patients’ risk of preventable functional decline and rate of loss of independence.