title: Predictors of institutionalization for people with multiple sclerosis.
abstract: BACKGROUND
  Multiple Sclerosis (MS) is a chronic, progressive disease of the central nervous system with a high prevalence in Canada. While the disease course is highly variable, a significant portion of people with MS may spend more than 10 years living with severe disability, and many of those will eventually require full time institutional care. Despite the high personal and economic cost of this care, little is known about predictors of institutionalization.
  
  
  OBJECTIVE
  The objective of this study was to identify predictors of institutionalization.
  
  
  METHODS
  Longitudinal data from a university MS clinic database were extracted to explore nursing home placement over time of an urban subgroup. Cox regression analysis was performed with age of MS onset and sex, as well as baseline information obtained at the first MS clinic assessment: MS course, Kurtzke Expanded Disability Status Scale score, and functional system scores.
  
  
  RESULTS
  Older age of onset (p = .019) and higher baseline scores in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) were significant (p = .000, p = .000, p = .001, p = .000 respectively) predictors of nursing home placement.
  
  
  CONCLUSIONS
  Patients with older age of MS onset and those with baseline impairment in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) may be at higher risk for future institutionalization and should be assessed with particular care to determine potential avenues of support to minimize this.
authors.affiliation: Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Electronic address: lilian.thorpe@usask.ca.
authors.forename: Lilian U
authors.initials: LU
authors.lastname: Thorpe
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Knox
authors.affiliation: College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Jalbert
authors.affiliation: Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: June
authors.initials: J
authors.lastname: Hyun-Ja Lim
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Nickel
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Hader
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D001927:Brain Diseases / Q000209:etiology; D002170:Canada; D002908:Chronic Disease; D004185:Disability Evaluation; D006233:Persons with Disabilities; D018450:Disease Progression; D005260:Female; D006801:Humans; D007326:Institutionalization; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009735:Nursing Homes; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012306:Risk; D012720:Severity of Illness Index; D014505:Urban Population; D014549:Urinary Incontinence / Q000209:etiology
keywords: Institutionalization; Multiple sclerosis; Nursing facilities; Prognosis