Trajectories of functional decline and predictors in long-term care settings: a retrospective cohort analysis of Canadian nursing home residents

Abstract

Decline in the ability to perform activities of daily living (ADL) or ‘functional decline’ is a major health concern among aging populations. With intervention, ADL decline may be delayed, prevented or reversed. The capacity to anticipate the trajectory of future functional change can enhance care planning and improve outcome for residents. Methods This is a 36 months’ retrospective longitudinal analysis of LTC residents in five Canadian provinces. Group-based trajectory modelling (GBTM) was performed to identify distinct trajectories and resident attributes associated with membership of the trajectory groups. Results A total of 204 036 LTC residents were included in this study. Their admission mean age was 83.7 years (SD = 8.6), and 63.3% were females. Our model identified four distinct trajectories namely: ‘Catastrophic decline’ (n = 48 441, 22.7%), ‘Rapid decline with some recovery’ (n = 27 620, 18.7%), ‘Progressive decline’ trajectory (n = 30 287, 14.4%), and the ‘No/Minimal decline’ (n = 97 688, 47.9%) Residents’ admission ADL Hierarchy score was the single, strongest predictor of functional decline trajectory that residents followed. Residents with ADLH 5–6 OR 0.03 (0.03–0.04) were least likely to follow a catastrophic decline trajectory, while those with ADLH 5–6 OR 39.05 (36/60–41.88) were most likely to follow a minimal or no decline trajectory. Conclusion Results of this study further highlight the heterogeneity of health trajectory among residents in LTC setting, re-affirming the need for personalized care. The study shows who among residents would be most at risk for different levels of functional decline. The study findings provide useful information that would assist both immediate and advanced care planning as well as to forecast care personnel requirements into the future based on total acuity levels of residents.