Objective To explore the change patterns of activities of daily living （ADL） function over time among institutionalized elderly persons, to analyze the predictive effect of sleep quality on ADL trajectory, and to provide reference for taking intervention measures to improve their ADL function. Methods Residents who had stayed in 26 elder-care institutions in 5 administrative regions of Jinan were surveyed using the Mini-Mental State Examination, Barthel Index and Athens Insomnia Scale at baseline assessment, then they were followed up every 6 months for twice in terms of their ADL function change. Results A total of 296, 244 and 203 participants completed the baseline assessment, 6-month and 12-month follow-up assessments respectively. Their ADL function scored 78.62±25.90 at baseline and 74.31±27.78,74.11±27.81 at follow-up assessments. Three different ADL function trajectories were identified among 250 subjects who completed at least two assessments:high-level maintenance, medium decline and low-level maintenance. Logistic regression analysis showed that sleep quality, MMSE score and age could predict ADL function trajectories （P＜0.05,P＜0.01）. Conclusion Sleep quality can predict ADL function changes in institutionalized elderly persons, demonstrating the poorer sleep quality, the higher likelihood of being in low-level maintenance class. Measures should be taken to improve sleep quality of the institutionalized residents, thus to enhance their ADL function.