Prediction of institutionalization in the elderly. A systematic review.
OBJECTIVE
in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general population of developed countries.


METHODS
relevant articles were identified by searching the databases MEDLINE, Web of Science, Cochrane Library and PSYNDEXplus. Studies based on population-based samples with prospective study design and identification of predictors by multivariate analyses were included. Quality of studies and evidence of predictors were determined.


RESULTS
thirty-six studies were identified; one-third of the studies were of high quality. Predictors with strong evidence were increased age, low self-rated health status, functional and cognitive impairment, dementia, prior NHP and a high number of prescriptions. Predictors with inconsistent results were male gender, low education status, low income, stroke, hypertension, incontinence, depression and prior hospital use.


CONCLUSIONS
findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living. However, the methodical quality of studies needs improvement. More theoretical embedding of risk models of NHP would help to establish more clarity in complex relationships in using nursing homes.
Luppa
Melanie
M
Department of Psychiatry and Psychotherapy, University of Leipzig, Germany. Melanie.Luppa@medizin.uni-leipzig.de
Luck
Tobias
T
Weyerer
Siegfried
S
König
Hans-Helmut
HH
Brähler
Elmar
E
Riedel-Heller
Steffi G
SG
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology* / Q000523:psychology; D003704:Dementia / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005544:Forecasting; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data / Q000639:trends*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors