title: Predictors of institutionalization among home-dwelling older Finnish people: a 22-year follow-up study.
abstract: BACKGROUND
  Identification of predictive factors on institutionalization provides the basis for the development and application of preadmission assessment. There is a lack of evidence for predictors of institutionalization for older people.
  
  
  OBJECTIVE
  To examine the effect of predictive factors on institutionalization in home-dwelling 70-year-old people.
  
  
  METHODS
  The data were collected in 1991 by the clinical examinations, a postal questionnaire, and an interview from the residents of Turku, Finland, born in 1920 (n = 1032). Institutionalization was defined as entry into a nursing home or sheltered housing at any time during a 22-year follow-up.
  
  
  RESULTS
  A rate of institutionalization was 22.0%. In multivariable Cox regression analysis, impaired cognitive function (MMSE 18-26) (hazard ratio 1.71, confidence interval 1.24-2.36) and low BMI (<25 kg/m2) (compared to both BMI of 25-29.9 and that of ≥30, respectively, 1.88, 1.32-2.67, and 1.66, 1.05-2.60), having several falls during the previous year (2.50, 1.28-4.90).
  
  
  CONCLUSIONS
  We conclude that impaired cognitive function, low BMI, and frequent falling predicted institutionalization during the 22-year follow-up. To reduce or postpone institutionalization, interventions should target risk factors, such as frailty, physical limitations, and falling. In addition, community-based services according to the needs and functional ability of the home-dwelling older people should be developed.
authors.affiliation: Unit of Family Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 1, 20014, Turku, Finland. majosa@utu.fi.|City of Turku, Welfare division, Yliopistonkatu 30, Turku, Finland. majosa@utu.fi.
authors.forename: Marika
authors.initials: M
authors.lastname: Salminen
authors.affiliation: Department of Geriatrics, Faculty of Medicine, University of Turku, Kunnallissairaalantie 20, Turku, Finland.
authors.forename: Jenni
authors.initials: J
authors.lastname: Vire
authors.affiliation: Department of Geriatrics, Faculty of Medicine, University of Turku, Kunnallissairaalantie 20, Turku, Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Viikari
authors.affiliation: Institute of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.affiliation: Statcon Ltd., Savenvalajankatu 3 B 25, Turku, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Isoaho
authors.affiliation: Department of Geriatrics, Faculty of Medicine, University of Turku, Kunnallissairaalantie 20, Turku, Finland.
authors.forename: Aapo
authors.initials: A
authors.lastname: Lehtonen
authors.affiliation: Department of Geriatrics, Faculty of Medicine, University of Turku, Kunnallissairaalantie 20, Turku, Finland.|Division of clinical geriatrics Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
authors.forename: Matti
authors.initials: M
authors.lastname: Viitanen
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Turku, Lemminkäisenkatu 1, Turku, Finland.
authors.forename: Seija
authors.initials: S
authors.lastname: Arve
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Turku, Lemminkäisenkatu 1, Turku, Finland.|Hospital District of Southwest Finland, Kiinanmyllynkatu 4-8, Turku, Finland.
authors.forename: Sini
authors.initials: S
authors.lastname: Eloranta
keywords: Elderly; Institutionalization; Older people; Predictor