title: Caregiving and institutionalization of cognitively impaired older people: utilizing dynamic predictors of change.
abstract: OBJECTIVE
  The purpose of this study was to identify reliable predictors of nursing home entry over a 3-year period in a sample of 3,944 persons with dementia who resided in a home setting at baseline. Strengths of the analysis include a multiregional recruitment strategy, incorporation of salient caregiver characteristics, and a 3-year prospective design that allows for the modeling of change in important variables (e.g., care recipient functional status or caregiving indicators) when time to institutionalization is predicted.
  
  
  METHODS
  Data were derived from the control sample of the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE). A Cox proportional hazards model was used to predict time to institutionalization among individuals with dementia (baseline was enrollment into MADDE). Predictors included care recipient demographics, caregiver demographics, and time-varying measurements of care recipient functional status, caregiving indicators, and service utilization. Indicators of change were also incorporated to capitalize on the prospective data available.
  
  
  RESULTS
  Although several results were consistent with prior findings, caregiving indicators (i.e., burden and self-rated health) and community-based service use were significant predictors of earlier placement. Change in caregiver instrumental activities of daily living and care recipient activities of daily living were also related to expedited institutionalization.
  
  
  CONCLUSIONS
  The findings emphasize the importance of incorporating both care recipient and caregiver function and service use patterns when targeting programs designed to prevent or delay institutionalization for people with dementia.
authors.affiliation: PhD Program in Gerontology/Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536-0230, USA. jgaugle@uky.edu
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Gaugler
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Kane
authors.forename: Ted
authors.initials: T
authors.lastname: Clay
authors.forename: Robert
authors.initials: R
authors.lastname: Newcomer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011581:Psychological Tests