Dynamics of activities of daily living performance in institutionalized older adults: A two-year longitudinal study

Javier Jerez-Roig, MD, Lidiane Maria de Brito Macedo Ferreira, MD, José Rodolfo Torres de Araújo(Undergraduate student), Kenio Costa Lima, PhD

Disability and Health JournalVol. 10Issue 2p279–285
DOI: http://dx.doi.org/10.1016/j.dhjo.2016.12.001



It is fundamental to analyze the evolution of functioning for the planning of strategies aimed at preventing or delaying dependency. However, there is a lack of studies focused on the evolution of functional performance in institutionalized older adults in Latin America.


Verify the incidence of functional decline, functional maintenance and functional improvement in the basic activities of daily living (BADL) in institutionalized older adults, as well as analyze the evolution of functional performance.


A two-year, five-wave longitudinal study is presented herein, with assessments applied every 6 months, carried out in residents of 10 nursing homes in the city of Natal-RN (Brazil). The items ‘eating’, ‘personal hygiene’, ‘dressing’, ‘bathing’, ‘transferring’ and ‘walking’ were assessed by a 5-points Likert scale. Sociodemographic, institution-related and health-related variables were considered for descriptive analyses.


The sample consisted of 280 older adults, of which 150, 53.6% (95% CI: 47.7–59.3%) experienced decline, 94, 33.6% (95% CI: 28.3–39.3%) maintained functional performance, 40, 14.3% (95% CI: 10.7–18.9%) presented improvement at least in one assessment, and only 18 (6.4%; CI 95%: 4.1–9.9%) improved functional performance with no decline over the period. ‘Eating’ presented the highest decline (−0.54 points), followed by ‘walking’ (−0.43), ‘dressing’ (−0.35) and ‘transferring’ (−0.31). The BADL that suffered less decline were ‘toileting’ (−0.22), ‘personal hygiene’ (−0.24) and ‘bathing’ (−0.29).


Half of institutionalized older adults experienced functional decline and less than 15% improved functional performance. ‘Eating’ suffered the most pronounced decline, followed by mobility and self-care activities.