A Narrative Review of Physical Performance Changes in Dementia: Differences between Community and Nursing Home Setting

Abstract

Objectives

To investigate differences in longitudinal physical performance in individuals with dementia across care settings.

Design

Narrative review.

Setting and Participants

Older adults with moderate to severe dementia residing in the community or nursing home.

Methods

A systematic literature search was conducted in PubMed, Embase, and Web of Science. Included studies were longitudinal, with observational or care-as-usual control groups, with a follow-up ≥3 months, assessing physical performance in adults aged ≥65 years with dementia (Mini Mental State Examination score ≤20), in the community or nursing home setting. Eligibility screening and risk of bias were performed by 2 authors. We categorized physical performance-based tests into upper limb strength, lower limb strength, balance, endurance, flexibility, mobility, and combined physical performance. Physical performance changes were quantified within each study as percentage of change from baseline to follow-up, and were compared between community and nursing home setting using narrative synthesis.

Results

The search yielded 7813 studies, of which 20 were included (15 from nursing homes). Five of 20 studies were classified as having high risk of bias. In the nursing home setting, physical performance decline was observed across all domains (3- to 4-month follow-up: −6.1% to −7.7%, 5- to 7.5-month follow-up: −4.6% to −30.7%, 12- to 36-month follow-up: −27.3% to −68.2%). In the community setting, only combined physical performance declined (12–24 months: −18.6% to −33.8%).

Conclusions and Implications

Studies assessing longitudinal physical performance in the community and nursing home setting were identified and summarized. Physical performance declined after shorter follow-up periods across all domains in the nursing home setting, whereas in the community setting only combined physical performance declined. However, diversity in study characteristics, study populations and outcome measures, along with a deficiency of longer follow-up periods in the community setting, hamper interpretation. Future research should focus on physical performance trajectories in longitudinal within-group designs of community-dwelling individuals with dementia who transition to nursing homes.