Exploring the Factors that Influence Functional Performance among Nursing Home Residents

Abstract

Background: Unfortunately, functional impairment and disablement are generally accepted as normal consequences of aging. The Disablement Process Model contains four central disability concepts: active pathology, impairment, functional limitation, and disability. The Model's inclusion of psychological and environmental contexts, which may hasten or slow the disablement process, comprehensively explains functional outcomes. This comprehensive understanding of functional performance is needed to guide the development of interventions to prevent the downward trajectory predicted by the Disablement Model. Design: A secondary analysis using baseline data from the 12-month Restorative-Care Study, a randomized controlled-trial testing the impact of a restorative care intervention on function among Nursing Home (NH) residents. The sample included 492 NH residents (from 12 different NHs) with a mean age of 83.7 (SD ± 8.5) years, the majority of whom were Caucasian (55.1%), female (67.7%), and unmarried (70.5%). A stepwise multiple logistic regression model was used to test the impact of socio-demographic, physiologic, physical, psychosocial, and environmental factors on chair rise. Results: Three factors, strength (i.e., representing functional impairment), gait (i.e., representing functional limitation), and self-efficacy (i.e., representing intra-individual factors) were significantly associated with chair rise ability and together explained approximately 64% of the variance for this functional task. The variables in the final model were able to successfully classify 88.4% of the chair rise cases. Conclusions: The Disablement Model is a useful guide to understanding functional performance among NH residents. Early interventions focused on strengthening self-efficacy related to function and maintaining overall strength and ambulation may help older adults to maintain the ability to chair rise. Future research should test these interventions. As a secondary data analysis, study limitations include insufficient power to answer the hypotheses, some measurement concerns that may limit findings, and that the regional focus limits generalizability. Although hemoglobin was not found to be a significant factor to predict chair rise function, it is very likely that mild cases of low hemoglobin levels were insufficient to detect significant clinical differences in physical function. Future research efforts should focus on collecting hemoglobin levels at the time of functional testing, and classifying cases of anemia by levels of severity to increase clinical applicability.