title: The effect of adult day care services on time to nursing home placement in older adults with Alzheimer's disease.
abstract: OBJECTIVE
  This longitudinal study examined whether the use of adult day care services delayed time to nursing home placement in persons with Alzheimer's disease.
  
  
  METHODS
  Two hundred and eighteen adult day care clients with Alzheimer's disease were recruited from 16 adult day programs in a large metropolitan area. Two hundred and ninety eight persons with Alzheimer's disease but not using adult day care were recruited from a federally funded Alzheimer's diagnostic center and frequency matched to adult day care users on age, gender, race, and level of cognitive impairment. Participants were followed at 3-month intervals for up to 48 months. Cox proportional hazards models were used to examine the effects of adult day care and other fixed and time-varying factors on risk of nursing home placement.
  
  
  RESULTS
  Risk of nursing home placement increased significantly with the number of days of adult day care attendance, with this effect being substantially greater for men (hazard ratio or HR = 1.33; confidence interval or CI = 1.18-1.49) than for women (HR = 1.09; CI = 1.00-1.18). Participant disability and hospitalizations and caregiver age and burden were independent predictors, but their inclusion in the model did not alter the risk associated with adult day care.
  
  
  CONCLUSIONS
  More severe disease and greater caregiver burden did not explain the increased risk of nursing home placement among adult day care users with Alzheimer's disease. Rather, it appears that other unmeasured factors, such as a proclivity to institutionalize, may account for the association of adult day care to nursing home risk.
authors.affiliation: Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL 60612, USA. judy_j_mccann@rush.edu
authors.forename: Judith J
authors.initials: JJ
authors.lastname: McCann
authors.forename: Liesi E
authors.initials: LE
authors.lastname: Hebert
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
authors.forename: David W
authors.initials: DW
authors.lastname: Gilley
authors.forename: Neelum T
authors.initials: NT
authors.lastname: Aggarwal
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Miller
authors.forename: Denis A
authors.initials: DA
authors.lastname: Evans
mesh_terms: D000544:Alzheimer Disease; D002641:Chicago; D003631:Day Care, Medical / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D006801:Humans; D008137:Longitudinal Studies; D009735:Nursing Homes; D010343:Patient Admission; D010360:Patient Transfer; D016016:Proportional Hazards Models; D013997:Time Factors