Incontinence and Troublesome Behaviors Predict Institutionalization in Dementia

Abstract

Factors predicting the early institutionalization of demented patients were studied in 143 outpatients using univariate and multivariate life-table methods. Four types of factors were evaluated for prognostic value: severity of functional impairment, behavioral disorders, individual patient characteristics, and type of caregiver. After follow-up of 19 +/- 12 months, 51 patients had been institutionalized. Increased global severity of dementia, the presence of troublesome and disruptive behaviors, and incontinence increased the likelihood of institutionalization. The best predictors of institutionalization were paranoia, aggressive behavior, and incontinence. Neither individual patient characteristics (age, education, and gender) nor caregiver relationship to the patient (male spouse, female spouse, and male or female child) influenced institutionalization. Since troublesome behavioral disorders are potentially treatable aspects of dementia leading to institutionalization, their management should be a major focus of therapy in dementia.

Stroke and Incontinence

“…35,53 Ween et al 35 reported that 46% of 145 stroke survivors with incontinence returned to their own home after hospitalization compared with 79% of 278 continent stroke survivors. Only 15% of those initially continent after their stroke were later admitted to a nursing home compared with 38% of the incontinent group.…”

Antipsychotics and cognitive decline in Alzheimer's disease: the LASER-Alzheimer's disease longitudinal study

“…[1][2][3] They are associated with increased caregiver burden, 4 institutionalisation, 5 progression 6 and care costs. 1 Many people with Alzheimer's disease are treated with antipsychotics, often to ameliorate neuropsychiatric symptoms.…”

Functional Analysis and Treatment of Problem Behavior of Elderly Adults in Long‐term Care

“…Approximately 1.6 million (5%) of those older adults live in long-term care facilities (Aiken, 2001). Problem behaviors are the most common precipitating factor for institutionalization (O'Donnell et al, 1992;Plaud, Moberg, & Ferraro, 1998), and up to 80% of nursing home residents exhibit problem behaviors such as physical aggression, wandering, and repetitive vocalizations (Allen-Burge, Stevens, & Burgio, 1999;Meeks, 1996).…”