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Revista Clínica de Medicina de Familia

On-line version ISSN 2386-8201Print version ISSN 1699-695X


NIETO ROJAS, Isabel et al. Functional decline: incidence and value of several prediction rules in older persons living in community. Rev Clin Med Fam [online]. 2018, vol.11, n.3, pp.137-143.  Epub Oct 01, 2019. ISSN 2386-8201.


To investigate the incidence of functional decline (FD) experienced in 3 months, and the usefulness of different prediction rules.


Multicenter, prospective, cohort study (subgroups based on the FD risk according to prediction rules), with a follow-up period of 3 months.


Primary care. Health area.


Non-institutionalized patients aged ≥ 70, excluding those who present communication problems, dependence in ≥ 3 basic activities, terminally ill, or refusing to participate. Sample size for an estimated FD incidence of 15 %, precision 2 %, confidence level 95 %, and expected loss 10 %. Stratified sampling: first stage by cluster sampling and second stage by systematic sampling (1/15) of lists ordered by age.

Main measures:

At the beginning: morbidity and socio-demographic variables, Katz index (basic activities), Lawton-Brody index (instrumental activities), and 3-month prediction rules for FD (SHERPA, TRST, ISAR-PC and Inouye). After 3 months: FD (loss of ≥ 1 basic or instrumental activities according to Katz and Lawton-Brody, institutionalization, or death).


462 patients complete the study (losses: 3.75 %). Mean age 77.9 years old (SD: 6.3), 54.7 % women, mean number of pathologies 4.4 (SD: 2.2) and mean number of drugs 5.6 (SD: 3.3).

Incidence of FD after 3 months 9.4 % (CI95 %: 6.8-12.0 %), of which 0.7 % loss of basic activities; 3.7 % loss of instrumental activities; 3.4 % loss of basic and instrumental activities; 0.2 % institutionalization; and 0.4 % death.

The relative risk (RR) found in high-risk/risk groups according to the prediction rules examined was: SHERPA 1.98 (CI95 %: 0.84-2.85; p>0.05); TRST 2.21 (CI95 %: 1.24-3.95; p<0.01); ISAR-PC 2.68 (CI95 %: 1.807 - 6.70; p<0.05); and Inouye 2.03 (CI95 %: 1.10 - 3.74; p<0.05).


Low incidence of FD compared to other studies. Relative usefulness of FD prediction rules

Keywords : Aged; Functional decline; Prediction.

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