Predictors of nursing home placement in Parkinson's disease: a population-based, prospective study.
OBJECTIVE
To examine the rate and predictors of nursing home placement in patients with Parkinson's disease.


METHODS
Four-year prospective study.


METHODS
A population-based study in western Norway


METHODS
178 community-dwelling subjects with Parkinson's disease.


METHODS
Main outcome measure was the time from baseline to nursing home admission. Baseline evaluation of motor symptoms (Unified Parkinson's Disease Rating Scale, UPDRS), cognition (clinical dementia interview, Gottfries, Brane & Steen dementia scale, and Mini-Mental State Examination), depression (clinical interview and the Montgomery & Asberg Depression Rating Scale), and psychotic symptoms (UPDRS Thought Disorder item) were performed.


RESULTS
Forty-seven patients (26.4%) were admitted to a nursing home during the 4-year study period. Institutionalized patients were older, had more advanced Parkinson's disease with more severe motor symptoms and impairment of activities of daily living, were cognitively more impaired, were more often living alone, and had more hallucinations than those who continued to live at home. Duration of disease, levodopa dose, and gender distribution did not differ between the two groups. A Cox proportional hazards linear regression analysis showed that old age, functional impairment, dementia, and hallucinations were independent predictors of nursing home admission.


CONCLUSIONS
Both motor and neuropsychiatric symptoms contributed to institutionalization, but the presence of hallucinations was the strongest predictor. This finding indicates it is possible that effective treatment of hallucinations may reduce the need for institutionalization in patients with Parkinson's disease.
Aarsland
D
D
Section of Geriatric Psychiatry, Rogaland Psychiatric Hospital, Central Hospital of Rogaland, Stavanger, Oslo, Norway.
Larsen
J P
JP
Tandberg
E
E
Laake
K
K
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018672:Community Health Planning; D003704:Dementia / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment; D006212:Hallucinations / Q000209:etiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009664:Norway; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index