Predictors of Institutionalization of Dementia Patients in Mild and Moderate Stages: A 4-Year Prospective Analysis

Abstract

Background: Institutionalization is the most important milestone in the care of dementia patients. This study was aimed at identifying relevant predictors of institutionalization in a broad empirical context and interpreting them on the basis of the predictor model proposed by Luppa et al. [Dement Geriatr Cogn Disord 2008;26:65-78]. Methods: At the start of this study, 357 patients with mild to moderate dementia were examined by their general practitioners, and a telephone interview was conducted with their caregivers. Four years later, the outcomes ‘institutionalization' and ‘death' were determined from health insurance data. Forty-one variables were examined for their predictive influence by univariate and multivariate Cox regression. Results: The risk of institutionalization increased significantly (p ≤ 0.05) with older ages of patients [hazard ratio (HR) = 1.05] and caregivers (HR = 1.03), a higher educational level of the caregiver (HR = 1.83), greater use of community health services (HR = 1.59), greater caregiver burden (HR = 1.02), and when the caregiver and patient lived apart (HR = 1.97). Conclusion: The results show that there is a multifactorial influence on institutionalization of dementia patients by sociodemographic, health-related, and psychological aspects as well as the care situation, thus validating the predictor model by Luppa et al. [Dement Geriatr Cogn Disord 2008;26:65-78]. Caregiver burden was found to be the strongest predictor accessible to interventions.

Factors Associated with the Caregivers’ Desire to Institutionalize Persons with Dementia: A Cross-Sectional Study

“…On the contrary, cohabitation protects against DTI. This finding is in accordance with other studies [8, 12] and suggests that living together has a more important influence on DTI than the type of relationship within the dyads, which was not independently associated. Indeed, it is to be expected that more time, organization, and effort is needed to provide informal care when not sharing the same household.…”

“…Concerning non-modifiable factors, corresponding to previous work, it was concluded that caregiver age [11, 12, 35], professional situation [40], and educational level [12] were positively associated with DTI. The latter can be explained by the fact that highly educated CG may be better informed about the possibilities, may have less problems to pay for institutional care, and may be less prepared to adapt or give up their professional career for caregiving.…”

“…At first sight, this is a rather counterintuitive result, however, this seemingly paradoxical observation was also found in several other studies. López et al [14] concluded that the use of formal services was associated with DTI, while others found a positive association between actual institutionalization and service use [11], use of community-based services [12, 13], and respite care in general [13]. It is important to keep in mind that an association does not assume any causal relationship and that this perceived paradox can be attributed to various reasons.…”

“…The latter is preferable because it positively affects the health-related quality of life of the PWD (Vandepitte et al [9]) [10], and avoids rapid declines in health and eventually increased mortality [11]. Even more, staying at home is suspected to have financial benefits for the healthcare system as a result of avoided institutionalizations [12, 13]. …”

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

“…Research also indicates that persons with dementia experience more care transitions than others (Coleman & Boult, 2003) and have a higher risk of adverse events such as medication errors, hospitalizations, stress and anxiety, and other problems than those without the disease (Manderson et al, 2012). Although most individuals with dementia are cared for at home, the progression of the disease often leads to higher levels of care (McCabe, You, & Tatangelo, 2016), with increased likelihood of institutionalization over time (Eska et al, 2013).…”