Functional decline and mortality in long-term care settings: Static and dynamic approach

Functional impairment is known to be associated with higher mortality risk and adverse health outcomes. However, little is known about whether functional decline could predict mortality among the elderly in the long-term care setting. This is a prospective cohort study in two veteran homes in northern Taiwan with active use of the minimum data set (MDS). Evaluation tools retrieved from the MDS, including MDS Resource Utilization Group-III for Activities of Daily Living (RUG-III ADL), MDS Cognitive Scale, MDS Social engagement, triggers for resident assessment protocol (RAP) and Pain scale, were utilized for the analysis. A total of 1125 male participants were included in this study. The mean age of the participants was 83.1 ± 5.1 years, and 65 (5.8%) developed physical functional decline within a 6-month period. Participants with functional decline [odds ratio (OR) 2.305, 95% confidence interval (CI) 1.002–5.303], poor baseline functional status (OR 1.116, 95% CI 1.002–1.242), positive RAP triggers for dehydration (OR 13.857, 95% CI 3.07–62.543), and underlying chronic lung diseases (OR 2.279, 95% CI 1.149–4.522), depression (OR 2.994, 95% CI 1.161–7.721), and cancer (OR 3.23, 95% CI 1.078–9.682) were more likely to have an additional 12-month mortality. By contrast, Parkinsonism (OR 3.875, 95% CI 1.169–12.841), increase in sum of RAP triggers (OR 6.096, 95% CI 2.741–13.562), and positive RAP triggers for cognitive loss (OR 3.164, 95% CI 1.612–6.212) and mood (OR 2.894, 95% CI 1.466–5.71) are strong predictors for functional decline within 6 months. Physical function decline within 6 months predicted the subsequent 1-year mortality, whereas increased sum of RAP triggers and positive trigger for cognitive loss and mood were associated with functional decline.