title: Precipitating and predisposing events and symptoms for admission to assisted living or nursing home care.
abstract: BACKGROUND
  In Canada, the rise of private-pay assisted living facilities is changing the long-term care landscape. Even so, few clinical implications of having these facilities in the spectrum of care have been studied. Our objective was to compare events and symptoms that might predispose and precipitate a move of older adults to assisted living or to a nursing home.
  
  
  METHODS
  Cross-sectional, descriptive Nova Scotia survey of residents and family members on admission. Health-care use and dementia diagnosis were recorded from the admission record. Dementia was staged using the Global Deterioration Scale and the Dependence Scale. The SymptomGuide, a standardized dementia symptom inventory, was used to assay which symptoms were most influential in the decision to seek long term care. Caregiver stress was elicited by a self-report questionnaire.
  
  
  RESULTS
  Of 353 people admitted during the enrolment period, 174 (49%) took part in the survey. Most (97; 55.7%) were involved in a move from the community to a nursing home, 54 (31.0%) from the community to assisted living, and 23 (13.2%) from assisted living to a nursing home. In each setting, dementia was the commonest predisposing factor (seen in >90%) with a precipitating event seen in 120 (69%) people. The precipitating events included a medical illness (n = 97; 55%) or caregiver illness, death or move (33; 19%). Dependence was associated with place of care, with more severely impaired people more commonly represented in people who moved to nursing homes.
  
  
  CONCLUSIONS
  People move from the community chiefly due to dementia, and often with a precipitant. Compared with a move to assisted living, moving to nursing homes generally indicates greater dependence, and typically worse dementia severity. Even so, assisted-living facilities are not just for the "worried well", but are used by people with dementia, caregiver stress, and recent hospitalization.
authors.affiliation: DGI Clinical, Halifax, NS;
authors.forename: James Kh
authors.initials: JKh
authors.lastname: Rockwood
authors.affiliation: DGI Clinical, Halifax, NS;
authors.forename: Matthew
authors.initials: M
authors.lastname: Richard
authors.affiliation: DGI Clinical, Halifax, NS;
authors.forename: Kathryn
authors.initials: K
authors.lastname: Garden
authors.affiliation: Department of Social Work & Centre for Health care of the Elderly, Halifax, NS;
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hominick
authors.affiliation: DGI Clinical, Halifax, NS; ; Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.affiliation: DGI Clinical, Halifax, NS; ; Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
keywords: aging; dementia; frailty; hospitalization; long-term care