title: The incremental effect of dementia-related problem behaviors on the time to nursing home placement in poor, frail, demented older people.
abstract: OBJECTIVE
  To examine the incremental effect of dementia-related problem behaviors (DRPBs) on the risk of and time to nursing home placement (NHP) in poor, frail, demented older people.
  
  
  METHODS
  Client assessments were reviewed retrospectively for clinical, functional, and cognitive information, particularly the presence of DRPBs and the time during enrollment at which they occurred.
  
  
  METHODS
  The Georgia Community Care Services Program (CCSP), a Medicaid 1915-C home and community-based services program (HCBS).
  
  
  METHODS
  A random sample of demented clients (n = 204) discharged during fiscal year 1996 from four CCSP regions.
  
  
  METHODS
  The risk of and time to nursing home placement. Cox proportional hazards models and an extended Cox model with a time-varying covariate for the presence of DRPBs were used to evaluate the risk factors associated with NHP in demented older people. Kaplan-Meier survival curves were used to estimate the time to NHP for several risk groups.
  
  
  RESULTS
  In demented older people in a HCBS program, having a DRPB was found to increase the hazard rate of NHP. Having a problem behavior shortened average median survival in the community by approximately 2 years.
  
  
  CONCLUSIONS
  DRPBs in demented older people shorten the time to NHP. Exploration of effective interventions is warranted.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health of Emory University, Atlanta, Georgia 30322, USA. vphil01@sph.emory.edu
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Phillips
authors.forename: Sadhna
authors.initials: S
authors.lastname: Diwan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications* / Q000523:psychology; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007326:Institutionalization; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D009735:Nursing Homes; D011203:Poverty; D012189:Retrospective Studies