Predictors of entering 24‐h care for people with Alzheimer's disease: results from the LASER‐AD study

Abstract

SUMMARYObjectives Many studies have investigated predictors of people with dementia entering 24-h care but this is the first to consider a comprehensive range of carer and care recipient (CR) characteristics derived from a systematic review, in a longitudinal cohort study followed up for several years. Methods We interviewed 224 people with Alzheimer's disease (AD) and their carers, recruited to be representative in terms of their severity, sex and living situation as part of the LASER-AD study; and determined whether they entered 24-h care in the subsequent 4.5 years. We tested a comprehensive range of characteristics derived from a systematic review, and used Cox proportional hazard regression to determine whether they independently predicted entering 24-h care.Results The main independent predictors of shorter time to enter 24-h care were the patient being: more cognitively or functionally impaired (hazard ratio (HR) ¼ 1.09; 95% CI ¼ 1.06-1.12) and (HR ¼ 1.04 95% CI ¼ 1.03-1.05), having a paid versus a family carer (HR ¼ 2.22; 95% CI ¼ 1.39-3.57), the carer being less educated (HR ¼ 1.43; 95% CI ¼ 1.12-1.83) and spending less hours caring (HR ¼ 1.01; 95% CI ¼ 1.00-1.01). Conclusion As having a family carer who spent more time caring (taking into account illness severity) delayed entry to 24-h care, future research should investigate how to enable carers to provide this. Other interventions to improve patients' impairment may not only have benefits for patients' health but also allow them to remain longer at home. This financial benefit could more than offset the treatment cost.

Determinants of time to institutionalisation and related healthcare and societal costs in a community-based cohort of patients with Alzheimer’s disease dementia

“…Studies have shown earlier institutionalisation among patients when their caregivers are employed, have a higher level of education or have a higher income [ 3 ]. Caregiver factors associated with institutionalisation of people with AD in the LASER-AD study were having a paid versus family carer, and the carer being less educated and spending fewer hours caring [ 32 ].…”

“…Our finding that several patient factors are associated with time to institutionalisation is in accordance with previous research. There is now considerable evidence that poorer cognition and lower functional abilities at baseline are associated with earlier institutionalisation of patients with dementia [ 3 , 32 ‒ 35 ]. Most studies assessed overall functional ability (i.e.…”

Caregiving for people with dementia in a rural context in South Africa

“…These stressors range from having to perform daily self-care tasks, such as bathing and feeding, to coping with adverse problem behaviours, such as wandering off and becoming disorientated in the environment. 10,11 In two studies it emerged that dementia patients' behavioural problems were one of the most important factors contributing to caregiver burden, with aggression being singled out as the critical symptom that is most often associated with burden. 12−14 It has been postulated that burden occurs as a result of the continuous vigilance that must ensue as a result of these other related behaviours.…”

Caring for the caregiver

“…10,11 The person experiencing these issues needs help to cope with the demands of caregiving. 10,11 The person experiencing these issues needs help to cope with the demands of caregiving.…”