Incidence and predictive factors of functional decline in older people living in nursing homes: a systematic review

Pau Moreno-Martin, Javier Jerez Roig*, Sandra Rierola-Fochs, Vinicius Rosa Oliveira, Pau Farres-Godayol, Dyego Leandro Bezerra de Souza , Maria Gine-Garriga, Jo Booth, Dawn Skelton, Eduard Minobes-Molina

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)
107 Downloads (Pure)


To review the evidence on incidence and predictive factors of functional decline (FD) in nursing home (NH) residents.
A systematic review of the literature.
Setting and Participants
Longitudinal studies involving individuals age 60 years and older living in a NH and with at least 2 functional capacity assessments were eligible.
The search was carried out up to June 2021 and was conducted in Embase, PubMed, Web of Science, Cochrane Library, CINAHL, Scopus, SciELO, and Google Scholar databases.
A total of 27 studies met the eligibility criteria, most of which were prospective, recruiting participants in more than 1 NH, and conducted in a single country. Studies reported a high rate of functional dependency at baseline and FD at follow-up; in 1 year, 38.9% to 50.6% of residents experienced FD. Predictive factors of FD that were significant in at least 2 of the included studies were cognitive impairment, functional status at baseline, urinary incontinence, length of institutionalization, age, depression, being married, being male, and stroke disease. Protective factors were licensed nursing hours and presence of a geriatrician within the NH staff.
Conclusions and Implications
This review highlights the high incidence of FD in NH residents and identifies risk and protective factors of FD that may support the design of preventative strategies for this vulnerable and frail population.
Original languageEnglish
Pages (from-to)1815-1825.e9
JournalJAMDA: The Journal of Post-Acute and Long-Term Care Medicine
Issue number11
Early online date6 Jun 2022
Publication statusPublished - 1 Nov 2022


  • activities of daily living
  • functional decline
  • ADLs
  • care homes
  • nursing homes
  • incidence
  • older adults
  • systematic review
  • aged
  • older people

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Health Policy
  • Physical Therapy, Sports Therapy and Rehabilitation
  • General Nursing


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