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PubMed1998

Predictors of institutionalization for people with dementia living at home with a carer.

OBJECTIVE: This article examines the relationships between behaviour, psychological functioning, the caring environment and subsequent institutionalization in patients with dementia living at home with a carer. DESIGN: Longitudinal study of behaviour in dementia, with a nested case-control study to investigate predictors of institutionalization. SETTING: Subjects with dementia, known to service, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: 100 people with dementia (Alzheimer's disease and/or vascular dementia) who were living at home with a carer at the start of the study. MEASURES: At 4-monthly intervals, the carers were interviewed and the subjects with dementia were assessed cognitively. Subjects' behaviour and psychological functioning were assessed using the Present Behavioural Examination. RESULTS: The characteristics which best predicted institutionalization 1 year later were: excessive night-time activity; immobility or difficulty in walking; incontinence; being away from a carer for more than 16 hours a week; and being cared for by a female. Aggressive behaviour was not associated with an increased chance of entry into an institution 1 year later, although it was more prevalent 4 months before entering an institution. CONCLUSIONS: Both behaviour and psychological functioning and the caring environment can help in predicting which patients with dementia currently living at home will enter an institution 1 year later. These predictors are not the same as those which are the immediate cause of institutionalization.

Activities of Daily Living↗

PubMed2005

Major depression as a risk factor for early institutionalization of dementia patients living in the community.

OBJECTIVE: Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact of major depression on the institutionalization rate of community-dwelling dementia patients. DESIGN: Prospective cohort study. SETTING: Paris, France. PARTICIPANTS: Three-hundred forty-eight consecutive dementia outpatients of a geriatric clinic (mean age: 81 years, 69.8% women, 65.5% dementia of Alzheimer's type, mean baseline MMSE score: 20.5), followed between 1997 and 2002 (mean follow-up: 20.5 months). RESULTS: Twenty-five percent of the patients met the criteria of major depression at baseline, and only 30.3% of these received antidepressant medication. Major depression at baseline was independently associated with nursing home admission within one year of the baseline assessment. Antidepressant medication tended to protect against this outcome, but not to a statistically significant extent. CONCLUSIONS: Major depression at baseline is an independent risk factor for early institutionalization of dementia sufferers. Early institutionalization is defined in this study as nursing home placement within a year of diagnosis with dementia at our specialized outpatient center. The study highlights the need for better management of depression among dementia outpatients. Further investigation is needed to evaluate the protective effect of antidepressant medication (and/or non-pharmacological therapies) on the institutionalization rate.

Aged↗

PubMed1988

Cognitive disturbance in hospitalized and institutionalized elders.

The purpose of this study was to examine the relationship between empirical findings and a theoretical model of cognitive disturbance among 94 hospitalized and 78 institutionalized elders. Path analysis was used to determine the magnitude of relationships between variables described in the model. Neural function was the only variable in both groups that was significantly associated with greater cognitive disturbance. In the hospitalized group, neural structural changes and physiologic alterations contributed indirectly to cognitive disturbance by their effects on neural function. Further, neural function indirectly affected cognitive disturbance through its effects on sensory deficits. In the institutionalized group, environmental deficits and neural functions were significantly related to greater cognitive disturbance. Except for the direct effects of neural function on activity limitations and physiologic alterations on mental health, all the relationships between the variables described by the model were significantly different between hospitalized and institutionalized elders. The results suggest that different interventions to reduce cognitive disturbances may be required for institutionalized and hospitalized elders.

Activities of Daily Living↗

PubMed1999

Association between institutionalization and carriage of multiresistant bacteria in the elderly at the time of admission to a general hospital.

The impact of institutionalization on the carriage of multiresistant bacteria among the elderly was assessed prospectively by comparing the carriage rate in institutionalized patients over 70 years of age to the carriage rate in patients over 70 living at home (58 patients/group). Nares, skin, and rectal swabs were obtained within 24 h of admission to the hospital. Among the 20 carriers identified, 75% came from institutions. Significantly, institutionalized patients were incontinent (P < 0.001), less autonomous than those living at home (P < 10(-6)), and had taken antibiotics recently (P < 0.02). The primary characteristics associated with bacterial colonization were institutional living (P < 0.02), having at least one underlying disease (P < 0.001), dependence (Karnofsky index < or = 50; P < 0.02), recent treatment with antibiotics (P < 0.02), and the presence of skin lesions (P < 0.02). Among the risk factors identified, institutionalization can be readily determined upon admission; systematic communication of carrier status of transfer patients would improve overall patient care.

Aged↗

PubMed1996

Use of albumin as a predictor of mortality in community dwelling and institutionalized elderly populations.

This study was undertaken to identify variables that could explain the association between low albumin and a 9- to 12-year mortality follow-up among 287 community- dwelling and 176 institutionalized people aged 60 years and over. A wide array of nutrition assessment variables was simultaneously examined in this population to identify confounders of the association. The results show that the risk of mortality for subjects with albumin values of 40 g/liter and over was 0.46 of the risk for those with albumin values below 40 g/liter, after controlling for the confounders age, blood urea nitrogen, triglyceride, history of diseases, and inability to shop owing to medical conditions. Similarly, albumin was also inversely associated with mortality among institutionalized subjects even after controlling for the confounders age, sex, blood urea nitrogen, transferrin, and history of stroke. However, the association was no longer significant among the institutionalized population once the deaths that occurred within the first 3 years after study participation were eliminated. The results indicate that albumin is a long-term predictor of mortality among noninstitutionalized subjects and increased mortality is not only a result of age, history of chronic diseases, medication use, or protein intake. Among institutionalized subjects, albumin appeared to be a short-term predictor of mortality.

Aged↗

PubMed2006

Characteristics of the institutionalized and community-residing oldest-old in China.

Existing research on the institutionalized population of older adults is primarily limited to Western countries. This study is the first to use nationally representative data to examine differences in the institutionalized and community-residing population of the oldest-old (ages 80+) in China. Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (1998, 2000, and 2002), we examine differences in sociodemographic characteristics, family caregiving resources, health practices, religious activity, chronic conditions, and mortality risk. The results indicate that the institutionalized oldest-old are younger, male, reside in urban areas, have lower family-care resources, and exhibit poorer health compared to those living in the community. We also find that the 2-year mortality risk for institutionalized elders is 1.35 times greater than for those residing in the community. However, the mortality differential is eliminated once the sociodemographic, family caregiving, and health characteristics of the oldest-old are taken into account. The implications of these findings are discussed.

Aged, 80 and over↗

PubMed1999

Family experiences related to the decision to institutionalize an elderly member in Taiwan: an exploratory study.

Industrialization and urbanization have changed the structure of Taiwanese families. Placing elder family members with impairments in nursing homes has become a new caregiving alternative. However, Taiwanese commonly consider this placement to be a violation of traditional filial obligation. Therefore, institutionalization is a highly sensitive cultural issue. Data were gathered through semi-structured interviews with nine family members, revealing three major processes in the decision of institutionalization -- breaking harmony, rebuilding harmony and evolution, as well as four important factors that influence the decision -- the quality of the relationship between the elder and his/her family, characteristics of the elder, financial condition of the family and perceived public opinion toward institutionalization. The findings suggest that the decision process in institutionalization is a gradual, fluid, cyclical movement without definite steps.

Adult↗

PubMed2001

The utilization of antidepressants in community-dwelling and institutionalized elderly--results form a representative survey in Germany.

Given its widespread occurrence and consequences, old-age depression has to be regarded as a major public health problem. Drug treatment has been proven effective in the majority of elderly individuals suffering from depression. This study presents pharmacoepidemiological data regarding the use of prescribed antidepressants and those purchased over the counter in the elderly. Furthermore, it links the data to simultaneously assessed depressive symptomatology. A representative survey on the utilization of prescription and over-the-counter antidepressant drugs and depressive symptomatology in community-dwelling (n = 1193) and institutionalized elderly individuals (n = 470) aged 75 and over was conducted in an urban region of Germany. Antidepressant use was found to be remarkably low (synthetic antidepressants: 2.2% of community dwelling individuals, 3.6% of institutionalized individuals; phytopharmaca containing hypericum perforatum: 4.2% of community dwelling individuals, 2.8% of institutionalized individuals). Two-thirds of the individuals treated with synthetic antidepressants received tri- and tetracyclic drugs, which were given at lower dosages than recommended for depression treatment. Selective serotonin reuptake inhibitors (SSRIs) were introduced in community-dwelling individuals only; none of the individuals cared for in residential and nursing homes received SSRIs. Only a minority of individuals with depressive symptoms were treated with antidepressants. The data suggests underutilization of antidepressants in the elderly, in which institutionalized elderly seem especially disadvantaged. The results call for increased efforts to discuss mental health issues in the public and to share scientific knowledge about symptoms, course and treatment options for depression. Furthermore, geronto-psychiatric competence of medical professionals, especially GPs, has to be systematically developed.

Aged↗

PubMedDate not supplied

Brain atrophy evaluated by computed tomography in independent and institutionalized hip fracture patients.

PURPOSE: To examine if there is an association between brain computed tomography (CT) findings and place of residence in a series of hip fracture patients. METHOD: The CT scans taken immediately after hip fracture of 215 patients (mean age 81.6 years) living in their own homes or otherwise independently (home-dwelling group) and 95 patients (mean age 82.5 years) permanently institutionalized (institutionalized group) were analysed. RESULTS: The institutionalized patients had significantly more cortical cerebral (frontal, p = 0.004; temporal, p = 0.007; parietal, p < 0.001) and central cerebral (third ventricle width, p < 0.001; frontal horn width, p < 0.001; midbody width, p < 0.001) atrophy than the home-dwelling ones. This was also true of atrophy in the white-matter (WM) area (p < 0.001). The institutionalized patients also had more atrophy of the cerebellar hemisphere (atrophy of the cerebellopontine angle cistern, p = 0.002, greater fourth ventricle width, p = 0.020). No significant difference was seen in the incidence of brain infarcts. CONCLUSIONS: Hip fracture patients living in institutions have more brain atrophy than those living independently. The brain atrophy may be one factor in the multiple mechanism underlying their institutional admission.

Aged↗

PubMed1992

Social networks, institutionalization, and mortality among elderly people in the United States.

This study focuses on the effect of social networks on institutionalization and mortality among elderly people in the United States. Data are from the Longitudinal Study of Aging (LSOA), which incorporates a baseline interview in 1984 and a follow-up interview two years later. The study population consists of a sample of 5,151 noninstitutionalized elderly people who were 70 years of age or older in 1984. Multivariate analyses using logistic regression revealed that social networks are negatively related to the likelihood of institutionalization and mortality when controlling for sociodemographic characteristics and baseline health status. Elderly people who participated in some form of social activity decreased their risk of institutionalization by almost one-half, whereas living alone increased the likelihood of institutionalization. Participating in social activities and visiting or talking with friends or relatives was negatively related to the likelihood of mortality.

Activities of Daily Living↗

PubMed1997

Risk of institutionalization among community long-term care clients with dementia.

South Carolina Community Long-Term Care (CLTC) data were used to identify factors increasing the risk of institutionalization in people with dementia. Clients diagnosed with dementia and observed at least twice between June 1993 and December 1994 (N = 786) were studied. Logistic regression determined that clients with a decline in ADL function who were white, had a nonrelative or child as a caregiver, and were diagnosed with Alzheimer's disease were at increased risk of institutionalization. Identifying CLTC clients at increased risk of institutionalization could be useful in designing additional interventions to prevent institutionalization or in planning the transition to institutional care.

Activities of Daily Living↗

PubMed2003

Caregiving and institutionalization of cognitively impaired older people: utilizing dynamic predictors of change.

PURPOSE: The purpose of this study was to identify reliable predictors of nursing home entry over a 3-year period in a sample of 3,944 persons with dementia who resided in a home setting at baseline. Strengths of the analysis include a multiregional recruitment strategy, incorporation of salient caregiver characteristics, and a 3-year prospective design that allows for the modeling of change in important variables (e.g., care recipient functional status or caregiving indicators) when time to institutionalization is predicted. DESIGN AND METHODS: Data were derived from the control sample of the Medicare Alzheimer's Disease Demonstration Evaluation (MADDE). A Cox proportional hazards model was used to predict time to institutionalization among individuals with dementia (baseline was enrollment into MADDE). Predictors included care recipient demographics, caregiver demographics, and time-varying measurements of care recipient functional status, caregiving indicators, and service utilization. Indicators of change were also incorporated to capitalize on the prospective data available. RESULTS: Although several results were consistent with prior findings, caregiving indicators (i.e., burden and self-rated health) and community-based service use were significant predictors of earlier placement. Change in caregiver instrumental activities of daily living and care recipient activities of daily living were also related to expedited institutionalization. IMPLICATIONS: The findings emphasize the importance of incorporating both care recipient and caregiver function and service use patterns when targeting programs designed to prevent or delay institutionalization for people with dementia.

Adult↗

PubMed1986

Serum concentrations of 25-hydroxyvitamin D and vitamin D-binding protein in elderly people. Effects of institutionalization, protein-energy malnutrition and inflammation.

Serum concentrations of 25-hydroxyvitamin D (25-OH-D) and vitamin D-binding protein (DBP) were measured in institutionalized and non-institutionalized elderly people. The institutionalized subjects were found to have low serum 25-OH-D in confirmation of other studies, but their serum DBP levels were similar to those found in non-institutionalized elderly subjects. Serum DBP concentrations were slightly higher in elderly females than in males, while no age dependence was found for DBP. Elderly people with protein-energy malnutrition who lived in their own homes had slightly reduced serum DBP and 25-OH-D levels. Elderly subjects with infections or other diseases causing acute inflammation, as indicated by an elevated serum haptoglobin and C-reactive protein, had normal levels of DBP.

Adult↗

PubMed1999

Walking speed and stride length predicts 36 months dependency, mortality, and institutionalization in Chinese aged 70 and older.

BACKGROUND: Increasing emphasis is being placed on physical performance measures as an outcome predictor. It is uncertain whether one or two simple measurements will have predictive value compared with a battery of tests. OBJECTIVES: To assess whether simple performance measures such as walking speed and stride length will predict dependency, mortality, and institutionalization. DESIGN: A 3-year longitudinal study of a random sample of subjects. SETTING: Older people living in the community in Hong Kong, Special Administrative Region, China. SUBJECTS: A total of 2032 Chinese subjects aged 70 years and older were recruited territory-wide by proportional random sampling and followed for 3 years. MEASUREMENTS: Functional status was measured using the Barthel Index at baseline and follow-up. The time taken to walk a distance of 16 feet and the number of steps taken were measured at baseline. Stride length is estimated by dividing 16 by the average number of steps needed to complete the walk. Outcomes regarding dependency, mortality, and institutionalization at 36 months were recorded. RESULTS: After excluding subjects lost to follow-up and those who had died, data were available for 559 men and 612 women. Univariate analysis showed that reduced walking speed and stride length were associated with increased risk of dependency, mortality, and institutionalization. In multivariate analysis for dependency and mortality, stride length, walking speed, age, and sex were included in the best prediction model (ROC = 0.798 and 0.707, respectively), whereas only stride length was included in the prediction for institutionalization (ROC = 0.764). CONCLUSIONS: In terms of prevention or modifying outcomes, these two simple performance measures may be used as indicators for checking for occult disease and for interventional measures such as exercise prescription.

Aged↗

PubMed2006

Comparison of health-promoting behaviors of noninstitutionalized and institutionalized older adults in Korea.

PURPOSE: To compare the health-promoting behaviors of noninstitutionalized and institutionalized Korean older adults. DESIGN: Descriptive survey. METHODS: The study sample included 214 Korean older adults (108 noninstitutionalized and 106 institutionalized) aged 65 years or over living in Seoul and Daegu, Korea. Data were collected from April to August, 2003. Measures were the Health Promoting Lifestyle Profile (HPLP), the Rosenberg Self-Esteem Scale (RSES), and the General Self-Efficacy Scale. FINDINGS: The average scores for HPLP, self-esteem, and self-efficacy of noninstitutionalized older adults were higher than those of institutionalized participants. Noninstitutionalized participants also scored significantly higher than did the institutionalized participants on self-esteem and self-efficacy. CONCLUSIONS: Studies were focused on the effects of various nursing interventions for health promotion are needed for older adults, especially those in institutions.

Aged↗

PubMed1995

Dental health and treatment needs in institutionalized psychiatric patients in Italy.

The caries prevalence, oral hygiene status, periodontal health and the treatment needs were assessed in a group of institutionalized psychiatric patients in Catanzaro, Italy. Of the total sample of 297 subjects, 165 (55.6%) were males, the mean age was 55.1 yr, the great majority (90.6%) was able to care for themselves, on average they had been institutionalized for 12.9 yr, and almost two-thirds were schizophrenic (65%). They did not receive any assistance in daily oral hygiene procedures, only 7.4% had visited a dentist and exclusively for emergency care. A total of 33 (11.1%) patients were edentulous, and the multiple logistic regression analysis showed a highly significant increase of edentulousness with increasing age (P < 0.001). No caries-free subjects were found and among the dentate the DMFT and DMFS scores for all age groups were respectively 15.5 and 88.6. The stepwise linear regression analysis showed that the mean DMFT index increased with age (t = 6.86; P < 0.001), and in the partly or totally helpless patients it was significantly higher than in the self-sufficient patients (t = 2.78; P = 0.006). Of the 264 dentate subjects, only 25 (9.5%) had no need of dental treatment; 213 (80.7%) required extractions with a mean number per person of 6.3 and the need for conservative dental care was recorded in 154 (58.3%) patients with a mean need for patient of 2.8. Mean OHI-S score was 4.2 and the stepwise linear regression analysis showed that it increased with age (t = 5.73; P < 0.001) and with the length of institutionalization (t = 3.42; P < 0.001). Only 0.9% of the entire sample was found with healthy periodontal tissue; bleeding on probing or a higher score was found in 4.6% of examined sextants; calculus in 10.1%; shallow pockets and deep pockets in 19.6% and 64.8% of all sextants. The results of the multiple logistic regression analysis indicated that the number of subjects with deep pockets as highest score increased with increasing age (P<0.001), and with the increasing length of institutionalization (P=0.005). The findings of this study demonstrate high caries prevalence, poor oral hygiene and periodontal health, and extensive unmet needs for dental treatment. More coordinated efforts between the social and dental care sector must be maintained to serve adequately the need of this disadvantaged group.

Adult↗

PubMed2005

Caregiver psychological adjustment and institutionalization of persons with Alzheimer's disease.

UNLABELLED: This prospective study examines the relationship between caregiver psychological adjustment and institutionalization of persons with Alzheimer's disease (AD). METHOD: A 3-year longitudinal study was conducted with a clinic-based cohort of 396 persons with AD and their respective family caregivers. Caregiver adjustment was sequentially measured in 3-month intervals using standard scales of appraisal (perceived burden and satisfaction) and emotion (depressive symptoms and positive affect). RESULTS: In multivariable proportional hazards regression models predicting time to institutionalization controlling for AD severity, hazard ratios were significant for appraisal measures of caregiver adjustment, perceived burden (1.053; 95% confidence interval [CI], 1.014, 1.093), and satisfaction (.929; 95% CI, .883, .977). In contrast, levels of caregivers' positive and negative emotion did not reliably predict institutionalization. DISCUSSION: The findings highlight the importance of caregiver appraisals in decisions to institutionalize persons with a dementia syndrome, but the limited impact of caregiver emotion was unexpected and requires further study.

Adaptation, Psychological↗

PubMed1993

Do falls predict institutionalization in older persons? An analysis of data from the Longitudinal Study of Aging.

Data from the Longitudinal Study of Aging (LSOA) were analyzed to estimate the subsequent risk of institutionalization associated with a report of one or more falls, and to determine if the association is affected by controlling for demographic traits, chronic conditions, and disabilities present at baseline. Risk was estimated at two time points, 2 years and 4 years after baseline interview. A report of multiple falls at baseline was associated with an increased risk of institutionalization at both 2 years (odds ratio [OR] 3.1; 1.9-5.3) and 4 years (OR 2.6; 1.6-4.4) of follow-up. The risk was decreased but remained significant in a model controlling for age, sex, marital status, and selected chronic conditions associated with both report of falls and institutionalization. However, multiple falls were not significantly associated with institutionalization when measures of disability (number of difficulties with activities of daily living) were added to the model. These analyses suggest that multiple falls should be regarded as an important sentinel event to alert caregivers to the presence of underlying disease and disability that may require intervention.

Accidental Falls↗