title: Predictors of nursing home placement in Huntington disease.
abstract: OBJECTIVE
  To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement.
  
  
  METHODS
  Subjects were participants in the Huntington Study Group's Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using chi2 and Student's t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used.
  
  
  RESULTS
  Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents' average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p < 0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p < 0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% CI 1.083 to 3.564), impaired gait (HR 3.004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement.
  
  
  CONCLUSIONS
  Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.
authors.affiliation: University of California Davis, Sacramento, USA. Vicki.Wheelock@ucdmc.ucdavis.edu
authors.forename: V L
authors.initials: VL
authors.lastname: Wheelock
authors.forename: T
authors.initials: T
authors.lastname: Tempkin
authors.forename: K
authors.initials: K
authors.lastname: Marder
authors.forename: M
authors.initials: M
authors.lastname: Nance
authors.forename: R H
authors.initials: RH
authors.lastname: Myers
authors.forename: H
authors.initials: H
authors.lastname: Zhao
authors.forename: E
authors.initials: E
authors.lastname: Kayson
authors.forename: C
authors.initials: C
authors.lastname: Orme
authors.forename: I
authors.initials: I
authors.lastname: Shoulson
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy / Q000209:etiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006212:Hallucinations / Q000209:etiology; D006801:Humans; D006816:Huntington Disease / Q000150:complications / Q000523:psychology; D018476:Hypokinesia / Q000209:etiology; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index