title: Predictors of institutionalization of dementia patients in mild and moderate stages: a 4-year prospective analysis.
abstract: BACKGROUND
  Institutionalization is the most important milestone in the care of dementia patients. This study was aimed at identifying relevant predictors of institutionalization in a broad empirical context and interpreting them on the basis of the predictor model proposed by Luppa et al. [Dement Geriatr Cogn Disord 2008;26:65-78].
  
  
  METHODS
  At the start of this study, 357 patients with mild to moderate dementia were examined by their general practitioners, and a telephone interview was conducted with their caregivers. Four years later, the outcomes 'institutionalization' and 'death' were determined from health insurance data. Forty-one variables were examined for their predictive influence by univariate and multivariate Cox regression.
  
  
  RESULTS
  The risk of institutionalization increased significantly (p ≤ 0.05) with older ages of patients [hazard ratio (HR) = 1.05] and caregivers (HR = 1.03), a higher educational level of the caregiver (HR = 1.83), greater use of community health services (HR = 1.59), greater caregiver burden (HR = 1.02), and when the caregiver and patient lived apart (HR = 1.97).
  
  
  CONCLUSIONS
  The results show that there is a multifactorial influence on institutionalization of dementia patients by sociodemographic, health-related, and psychological aspects as well as the care situation, thus validating the predictor model by Luppa et al. [Dement Geriatr Cogn Disord 2008;26:65-78]. Caregiver burden was found to be the strongest predictor accessible to interventions.
authors.affiliation: Center of Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universitaet Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Eska
authors.affiliation: Center of Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universitaet Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Graessel
authors.affiliation: Center of Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander Universitaet Erlangen-Nuernberg, Erlangen, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Donath
authors.affiliation: German Research Center of Environmental Health, Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, Munich, Germany.
authors.forename: Larissa
authors.initials: L
authors.lastname: Schwarzkopf
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Lauterberg
authors.affiliation: German Research Center of Environmental Health, Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, Munich, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
keywords: Age; Caregivers; Community health services; Cost of illness; Home nursing; Long-term care; Models, theoretical; Nursing homes; Primary health care; Proportional hazard models