Table 2 Change in Functional Status

Burke 2021 [51]

Improvement in functional status as measured by the BI

At baseline: With dementia: BI: 21.3 (15.6)

At discharge: With dementia: Yes improvement: 145,838 (28.4%); No improvement: 233,592 (45.5%); Missing: 133,994 (26.1%)

Without dementia: Yes improvement: 156,950 (30.6%); No improvement: 210,436 (41.0%); Missing: 146,038 (28.4%)

Cations 2020 [38]

mBI

Adjusted odds ratio for individuals with dementia in residential TCPs (95% confidence interval) (multinomial regression analysis assessing factors associated with improved and worsened mBI scores from entry to exit of TCP. Improved = moved up one category (e.g. from ‘severe dependence’ to ‘mild dependence’ in 10-item mBI). Worsened = moved down one category

At discharge:

Improved (n = 9236) aOR = 0.70 (0.66–0.75)

Worsened (n = 9588) aOR = 0.69 (0.65–0.73)

Downer 2022 [46]

MDS

The difference in self-care function between admission and discharge was calculated; a change score greater than zero indicates functional improvement

At admission:

Mild CI (vs no CI) -0.71 p < -0.001; Moderate to severe (vs. no CI) -2.31 p < -0.001

At discharge:

Mild CI (vs no CI) -1.88 p < -0.001.; Moderate to severe (vs. no CI) -4.98 p < -0.001

Difference:

Mild CI (vs no CI) -1.51 p < -0.001; Moderate to severe (vs. no CI) -3.78 p < -0.001

Hang 2021 [19]

mBI

(score 0 to 100—higher scores indicate better ADL performance). Measured at admission and discharge from TCP to determine changes in functional ability that occurred during TCP

At baseline: Age 60–79 CI: 40.2 (32.5–47.8); No CI: 52 (42.5–61.5)

Age ≥ 80: CI: 50.1(45.6–54.9); No CI: 55.1 (47.9–62.4)

At discharge:

Age 60–79: CI: 52.8 (44.7–60.8) Mean difference 12.6 (6.11–19.1) p < 0.001;

No CI: 71.1 (60.9–81.3) Mean difference 19.1 (10.9–27.4) p <  < 0.001

Age ≥ 80: CI: 64.5 (59.6–69.4) Mean difference 14.2 (10.3–18.1) p < 0.001

No CI: 68.5 (60.3–76.6) Mean difference 13.3 (6.63–20.0) p < 0.001

Kosar 2017 [55]

Functional Improvement (ADL self-performance items in the MDS)

Difference between composite score at admission and score at first discharge assessment within 30 days was calculated. Functional improvement was indicated by a positive difference. Functional improvement = at least a one-point improvement in composite ADL score

At discharge:

51.9% of patients with delirium but no dementia had functional improvement, compared to 60.9% of persons with no dementia and no delirium RR 0.89 (0.87, 0.90)

46.2% of patients with delirium and dementia had functional improvement RR 0.87 (0.86, 0.88), compared to 53.3% of patients who had dementia but no delirium RR 0.87 (0.86, 0.88)

Lee 2008 [58]

7-item MDS-ADL Scale

(Regression analysis was used to examine the association between physical function, as measured by the MDS-ADL scale, and admission factors, with CPS as the covariate); 7 Item MDL-ADL scale rates ADL performance scores from independent (0) to total dependence (4), with a range of scores from 0 to 28

At 3 months, estimate is 0.20, 95% confidence interval (0.13–0.28), z score is 5.34 p < 0.0001

At 6 months, estimate is 0.36, 95% confidence interval (0.27–0.45), z score = 7.90 p < 0.0001

At 9 months, estimate is 0.34, 95% confidence interval (0.24–0.44), z score = 6.70 p < 0.0001

At 12 months, estimate is 0.37, 95% confidence interval (0.26–0.48), z score = 6.88 p < 0.0001

Lee 2011 [29]

BI

Improvement is shown by an increase in score from admission to 4 weeks after services

At baseline: With dementia: 24.0 ± 29.0; No dementia: 47.1 ± 33.6

At 4 weeks: Participants with dementia: 42.6 ± 29.4 p < 0.001; No dementia: 66.2 ± 32.9 p < 0.001

IADL

At baseline: With dementia: 0.5 ± 1.3; No dementia: 1.8 ± 2.4

At 4 weeks: Participants with dementia: 1.0 ± 1.7 p < 0.001; No dementia: 3.0 ± 2.8, P < 0.001

Loomer 2019 [44]

Improvement in self-care and mobility (difference between admission and discharge scores for self-care and mobility came from Section GG of the MDS 3.0 v1.14.1)

Improvement in composite self-care and composite mobility scores was calculated by subtracting participants’ admission score from their discharge score. The percentage of participants whose composite scores stayed the same or improved were calculated

Expected self-care and mobility

(a dichotomous variable to determine residents whose scores were the same or higher than expected

At discharge:

Percentage of residents whose observed self-care and mobility performance improved or stayed the same between admission and discharge:

Composite self-care score: mild CI 92.1 (p < 0.001, ref: intact cognition), moderate CI 87.2 (p < 0.001, ref: mild CI), severe CI 84.3 (p < 0.001, ref: moderate CI), no CI 95.5

Composite mobility score: mild CI 94.8 (p < 0.001), moderate CI 91.5 (p < 0.001), severe CI 87.6 (p < 0.001), no CI 97.0

Percentage of residents whose observed self-care and mobility scores at discharge are the same or higher than their expected discharge score:

Composite self-care:

mild CI 55.8 (p < 0.001, ref: intact cognition), moderate CI 51.0 (p < 0.001, ref: mild CI), severe CI 45.4 (p < 0.001; ref: moderate CI), no CI 63.3

Composite mobility score: mild CI 53.9 (p < 0.001, ref: intact cognition), moderate CI 48.5 (p < 0.001, ref: mild CI), severe CI 44.6 (p < 0.001, ref: moderate CI), no CI 62.3

Lueckel 2018 [62]

MDS ADL—Change in score between admission and discharge

The ADL score ranges from 0 (no impairment) to 28 (total dependence). It is considered an improvement in function if their discharge ADL score was less than their admission score

At discharge:

Among residents with cognitive impairment, 57.4% had functional improvement at discharge compared with 68.8% without impairment (RR 0.86, 99% CI 0.83, 0.88) (discharged within 30 days)

Madrigal 2021 [42]

The MDS 3.0 ADL assessment

For MDS, scores are 0–28, with higher scores indicating lower functional ability. Functional recovery = ADL scores at admission minus ADL scores at 30 days

Functional recovery scores were categorized into 3 groups: Functional improvement (score > 0); no change in function (score = 0); worse functional performance: (score < 0)

At baseline: with delirium: mean (SD) ADL score on SNF admission 18.3 (4.7) p < 0.001, SMD 0.44; no delirium: mean (SD) ADL score on SNF admission 16.1 (5.2)

At discharge: ADL score change from admission to follow up assessment, mean (SD)

Delirium: 0.6 (2.9) p < 0.001; no delirium: 1.8 (3.6) p < 0.001

At 1 month: Follow up assessment at 30 days unless unavailable, then 15-, 45-, 60- or 90- day assessment was used. Categorical ADL score change from admission to follow-up, No. (%):

worse functional performance: delirium 1991 (21.7) p < 0.001; no delirium: 2821(14.4) p < 0.001

no change: delirium 364(41.3); p < 0.001; no delirium:6655(33.9) p < 0.001

improved functional performance: delirium: 327 (37.1) p < 0.001; no delirium: 10,137(51.7) p < 0.001

Marcantonio 2003 [45]

Linear regression model to measure the association of persistent delirium symptoms and functional recovery as determined by the MDS ADL score; β for ADL change: positive change indicates worsening of ADL function

At baseline: Participants with delirium symptoms: 23 ± 9 p < 0.01

At 1 or 2 weeks: Participants with persistent delirium: β for ADL change = 3.6, 95% CI [2.2,5.0]

Linear regression model to measure association of persistent delirium symptoms and functional recovery as determined by MDS IADL score

At baseline: Participants with delirium symptoms: 21 ± 6 p < 0.01

At 1 or 2 weeks: Participants with persistent delirium: β for IADL change = 2.6, 95% confidence interval [1.4, 3.6]

Miu 2016 [30]

mBI

(Higher scores indicate greater independence in performance of activities of daily living). A gain of mBI score from admission to discharge indicates improvement

At baseline: Community-dwelling participants with CI: 47.1 ± 29.5; with dementia 35.7 ± 28.6; No CI: 60.6 ± 29.5

At discharge: Community-dwelling participants with CI:50.8 ± 27.7; with dementia: 46.2 ± 27.1; with no CI: 71.5 ± 27.2

At 1 month: Community-dwelling participants with CI: 48.9 ± 30.9; with dementia: 42.4 ± 30.7; with no CI: 67.8 ± 28.8

Wysocki 2015 [57]

MDS 3.0^a ADL change

(linear regression coefficient –Regression result predicting ADL Improvement); ADL change calculated as admission score minus discharge score, and so positive scores mean improvement, negative scores indicate decline. A negative coefficient estimate shows less improvement in ADLs

At discharge: Coefficient estimates (standard error):

Moderately impaired: -0.761 (0.011) p < 0.001; Severely impaired: -1.698 (0.016) p < 0.001; Dementia: -0.416 (0.013) p < 0.001; Any signs of delirium: -0.7333(0.026) p < 0.001