Physical function decline predictors in nursing home residents using new national quality indicators

Abstract

AimTo determine the predictors of physical function (PF) decline among nursing home residents using items from the Long‐term care Information system For Evidence (LIFE), a system launched in 2021 to ensure the quality of long‐term care.MethodsThe LIFE data of 1648 residents from 45 nursing homes in Japan were retrospectively collected in July 2021 (T0) and January 2022 (T1), including demographics, PF assessed by the Barthel index (BI), nutrition and oral health, and cognitive function. The Dementia Behavior Disturbance scale was used to assess the frequency of certain behaviors, such as “waking at midnight.” The predictors of PF decline, defined as a decrease ≥5 in the BI score at T1 compared with that at T0, were determined using mixed‐effects logistic regression analyses. PF at T0 was classified into high (>60 BI) and low (≤60 BI) groups.ResultsThe participants' mean age was 87.2 ± 7.1 years, and 45.3% experienced PF decline. The significant predictors of PF decline were age ≥ 90 years, body mass index <18.5 kg/m2, dementia diagnosis, moderate and severe cognitive impairments, not vocalizing reciprocal exchanges at will, always “waking at midnight,” and high PF at T0.ConclusionsThe LIFE items predicted PF decline among nursing home residents, suggesting that LIFE data can be used to ensure the quality of long‐term care. Geriatr Gerontol Int 2023; ••: ••–••.

Effect of COVID‐19 on physical function decline predictors in nursing home residents

“…For example, among long-term nursing home residents during the pandemic, the prevalence of worsening cognitive function was observed, 4 assuming that the outbreak was in some way related to "Waking at midnight," as sleep disturbances are strongly associated with the abnormal daytime behavior of patients with dementia. 1 Furthermore, a higher prevalence of depression symptoms among nursing home residents with Alzheimer's disease and related dementias was observed during the COVID-19 pandemic than previously. 5 Emotional issues, especially depression, can cause "not vocalizing reciprocal exchanges at will" and contribute significantly to a decreased appetite and unintentional weight loss.…”

“…8 It is true that "Yuryo-rojinhomu" plays an important role in the Japanese long-term care system after the Japanese government launched the Long-term Care Insurance Act in 2000. 1 However, the number of residents in "Special nursing home for the elderly" ("Tokubetsu-yogo-rojinhomu") is also very high, with 51 884 residents, compared with the 540 047 residents in nursing homes in 2021. 9 When discussing quality indicators for monitoring and evaluating the entire elderly care system in Japan, it may be more pragmatic to include special care nursing homes and other types of nursing homes in the assessment.…”

“…The term "cardiogenic dementia" was introduced in 1977 to refer to cognitive caused by heart disease. 1 Although the term is now obsolete, the relationship between cardiovascular disease and cognitive impairment has potential therapeutic implications, as does the role of vascular factors in Alzheimer's disease (AD). 2 Heart failure (HF) has also been shown to be associated with an increased risk of dementia and AD in the elderly.…”

“…1 "Long-term care Information system For Evidence (LIFE) items," which the editors established from the LIFE data from 45 nursing homes in Japan, are simpler and seem more user-friendly for nurses, even when residents have cognitive impairments, compared with existing scoring systems.…”

Reply to: Effect of COVID‐19 on physical function decline predictors in nursing home residents

“…We appreciate the comments 1 by Onishi and Otsuka on our article. 2 We ascertained the predictors of physical function decline over a 6-month period among nursing home residents using Long-Term Care Information System for Evidence (LIFE) items and data collected from July 2021 to January 2022. Onishi and Otsuka provided insightful comments regarding the influence of the social impact of COVID-19 on the study results and the limitation of the study setting including only Yuryo-rojin-homes, without considering various other long-term care (LTC) facilities.…”