Predictors of institutionalization in dementia: a three year longitudinal study.
Patients with dementia often require institutionalization when they can no longer care for themselves. The study examined demographic and clinical variables that predict the time until institutionalization in patients with dementia attending memory clinics. Of 970 patients recruited from nine memory clinics around Australia, 779 patients had dementia at baseline. Measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden, and medication use were completed for all patients. Patients were followed for three years. Overall, 197 (25.3%) of the patients with dementia were institutionalized within three years. Lower cognitive ability, lower functional ability, and more neuropsychiatric symptoms at baseline predicted a shorter time until institutionalization, as did use of antipsychotic medication. In addition, greater deterioration in cognitive ability, functional ability, and neuropsychiatric symptoms over the initial three months predicted a shorter time to institutionalization. The findings confirm that clinical features of dementia at baseline predict the time to institutionalization, as do greater changes in symptoms over three months independent of baseline levels.
Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
Henry
H
Brodaty
Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
Michael H
MH
Connors
Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
Jing
J
Xu
University of Melbourne, Austin Hospital, Melbourne, Australia.
Michael
M
Woodward
National Ageing Research Institute, Australia University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, Australia.
David
D
Ames
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003704:Dementia / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D019370:Observation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D013997:Time Factors
Alzheimer's disease; dementia; institutionalization; longitudinal; nursing home; survival analysis