Skip to main content

Research Repository

Advanced Search

Functional decline in residents living in nursing homes : a systematic review of the literature

Palese, Alvisa; Menegazzi, Giulio; Tullio, Annarita; Zigotti Fuso, Maria; Hayter, Mark; Watson, Roger


Alvisa Palese

Giulio Menegazzi

Annarita Tullio

Maria Zigotti Fuso

Mark Hayter

Roger Watson


Objectives To describe the functional dependence progression over time in older people living in nursing homes (NHs). Design 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. Results 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. Conclusions 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.


Palese, A., Menegazzi, G., Tullio, A., Zigotti Fuso, M., Hayter, M., & Watson, R. (2016). Functional decline in residents living in nursing homes : a systematic review of the literature. Journal of the American Medical Directors Association, 17(8), 694-705.

Journal Article Type Review
Acceptance Date Apr 1, 2016
Online Publication Date May 24, 2016
Publication Date Aug 1, 2016
Deposit Date Jun 1, 2016
Publicly Available Date Jun 1, 2016
Journal Journal of the American medical directors association
Print ISSN 1525-8610
Electronic ISSN 1538-9375
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 17
Issue 8
Pages 694-705
Keywords Activity of daily living; Functional decline; Nursing homes; Systematic review; Instruments
Public URL
Publisher URL
Additional Information Authors' accepted manuscript of article published in: Journal of the American medical directors association, 2016, v.17, issue 8.


Article.pdf (1 Mb)

Copyright Statement
© 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license

You might also like

Downloadable Citations