Nursing home institutionalization: a source of eustress or distress for the elderly?
OBJECTIVE
To investigate why elderly persons moved to a nursing home and detect any change in their psychopathological and cognitive profile, dependency and perceived QOL.


METHODS
We considered 100 elderly consecutively admitted to a nursing home, within 1 week of admission and 6 months later. Data were collected from medical and nursing records (medical and psychiatric history, ADL), interviews (MMSE, reasons for admission) and self-report instruments (GDS, BSI, WHOQOL-brief).


RESULTS
At admission, 68 subjects were able to participate in the survey and agreed to take part. Only 5.9% (n = 4) had moved to the nursing home by their own choice, 26.5% (n = 18) because they were lonely and 36.7% (n = 25) because they had no caregiver available. The reasons for admission reported by the interviewed residents only partly corresponded with the ones noted in their records. Twenty-six subjects had an MMSE score >or= 18 and agreed to undertake complete assessment. The scores of 20 of the 26 subjects exceeded the cut-off on the GDS and five of the nine BSI subscales. During the follow-up period, 19 of the 68 originally assessed residents died (33 of the entire sample of 100) and one refused to continue to take part in the survey. The mean MMSE and ADL scores of the 48 survivors decreased from 16.87 (SD +/- 7.32) to 14.27 (SD +/- 7.24; t = 4.89, p < 0.000) and from 8.22 (SD +/- 3.55) to 6.39 (SD +/- 3.56; t = 5.34, p < 0.000), respectively. The scores achieved on GDI and BSI subscales worsened in 20 survivors with MMSE >or= 18. The score achieved on the QOL physical health domain also worsened. Comparison of the subjects who died and survived during the follow-up period showed a significant difference in terms of ADL (6.60 SD +/- 4.221 vs 3.64 SD +/- 3.773 F = 11.639; p < 0.001).


CONCLUSIONS
The 68 original participants expressed feelings of loneliness and marginalization, but these experiences were not noted in their personal records. Most subjects presented psychiatric symptoms and cognitive decline. After 6 months, the clinical condition of the sample, particularly the females, had worsened, with a 33% mortality rate. This suggests that moving to a nursing home did not bring about improvement or stabilization; rather, psychiatric symptoms worsened and quality of life was perceived more poorly.
Scocco
Paolo
P
Department of Mental Health, Padua, Italy. scocco.paolo@virgilio.it
Rapattoni
Monica
M
Fantoni
Giovanna
G
D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003072:Cognition Disorders / Q000523:psychology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D006707:Homes for the Aged; D006801:Humans; D007326:Institutionalization; D007558:Italy; D008132:Loneliness / Q000523:psychology; D008297:Male; D009735:Nursing Homes; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life