Mobility and cognition at admission to the nursing home – a cross-sectional study

Abstract

BackgroundEarlier studies show that the main reasons for admission to long-term nursing home care are cognitive impairment and functional impairments of activities of daily life. However, descriptive evidence of mobility is scant. The aims of this study were to describe mobility at admission to nursing homes and to assess the association between mobility and degree of dementia.MethodsWe included 696 residents at admission to 47 nursing homes in Norway. Inclusion criteria were expected stay for more than 4 weeks and 65 years or older. In addition, younger residents with dementia were included. Residents with life expectancy shorter than six weeks were excluded. Mobility was assessed using the Short Physical Performance Battery (SPPB) and the Nursing Home Life Space Diameter (NHLSD). The Clinical Dementia Rating Scale (CDR) was used to describe the degree of dementia. The associations between mobility and degree of dementia was analysed using the Chi-square and the Kruskal-Wallis test (KW-test). When the KW-test indicated a statistical significant difference, we proceeded with planned group comparisons with the Mann-Whitney U-test. In addition, we performed multiple linear regression analyses to control for potential confounders.ResultsForty-three percent of the residents were not able to perform the balance test in SPPB. Twenty-four percent of the residents were not able to walk four meters, while only 17.6% had a walking speed of 0.83 m/s or higher. Sixty-two percent of the residents were not able to rise from a chair or spent more than 60 s doing it. The median score on NHLSD area was 22 (IQR 17) and the median score on NHLSD dependency was 36 (IQR 26). Residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia. Cognitive function was associated with SPPB and NHLSD dependency in the adjusted models.ConclusionNursing home residents form a frail, but heterogeneous group both in terms of cognition and mobility at admission. Mobility was negatively associated with cognitive function, and residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia.

Trajectories of physical performance in nursing home residents with dementia

“…Our result is a novel finding requiring further investigation to elucidate. We also observed that age, general medical health, and dementia severity were negatively associated with physical performance, associations well known across populations [5,[7][8][9]41].…”

“…People with dementia exhibit a greater decline in physical performance compared to cognitively healthy adults [9], and as dementia severity increases, physical performance progressively deteriorates [10]. However, this relationship is not as clear in NH residents as in community-dwelling older adults [5].…”

“…Dementia and physical performance impairments are major predictors for NH admission [3]. In NHs the prevalence of dementia ranges from 50 to 84% [1,4] and most residents have extensive physical-performance impairments [5,6]. Impairments in cognitive and physical performance often co-occur in older adults [7,8].…”

Normative Values for the Short Physical Performance Battery (SPPB) and Their Association With Anthropometric Variables in Older Colombian Adults. The SABE Study, 2015

“…The SPPB is calculated from three components: (i) time to complete a 2.4, 3, or 4m walk at the participant's usual pace, (ii) time to rise from a chair five times, and (iii) the ability to stand for up to 10 s with feet positioned in each of three ways (a side-by-side position, semi-tandem position, and tandem position) (9). The SPPB has been adopted in multiple observational studies, with higher scores indicating a higher level of PF and lower scores predicting adverse outcomes such as decreased mobility (10), falls (11), loss of independence in activities of daily living (ADLs) (12), hospitalization (8), longer hospital stays (13), nursing home admission (14), and all-cause mortality (15). Moreover, previous research has suggested that the SPPB can detect body composition changes (16,17) and inflammation (18), and a total score ≤ 9 points can distinguish between vigorous and frail persons (19).…”

Patient characteristics in three different working models of home based physiotherapy: a longitudinal observational study in primary health care in Norway

“…Recent studies from Norway show that the difference in mobility level and physical performance, measured by the Short Physical Performance battery (SPPB), are surprisingly similar between patients who make contact with home based services for the first time (2), and patients who are admitted to nursing homes (3). Langeland et al (2019) investigated the effect of a home based rehabilitation model, termed "reablement", in home-dwelling, older adults with a recent functional decline who were applying for home based services (2).…”