 |
|
Patient and Caregiver Characteristics and Nursing Home Placement in Patients With Dementia
Kristine Yaffe, MD;
Patrick Fox, PhD;
Robert Newcomer, PhD;
Laura Sands, PhD;
Karla Lindquist, MS;
Kyle Dane, BS;
Kenneth E. Covinsky, MD,MPH
JAMA. 2002;287:2090-2097.
Context The decision to institutionalize a patient with dementia is complex and is based on patient and caregiver characteristics and the sociocultural context of patients and caregivers. Most studies have determined predictors of nursing home placement primarily according to patient or caregiver characteristics alone.
Objective To develop and validate a prognostic model to determine the comprehensive predictors of placement among an ethnically diverse population of patients with dementia.
Design, Setting, and Participants The Medicare Alzheimer's Disease Demonstration and Evaluation study, a prospective study at 8 sites in the United States, with enrollment between December 1989 and December 1994 of 5788 community-living persons with advanced dementia.
Main Outcome Measures Time to nursing home placement throughout a 36-month follow-up period, assessed by interview and review of Medicare records, and its association with patient and caregiver characteristics, obtained by interview at enrollment.
Results Patients were divided into a development (n = 3859) and validation (n = 1929) cohort. In the development cohort, the Kaplan-Meier estimates of nursing home placement throughout 1, 2, and 3 years were 22%, 40%, and 52%, respectively. After multivariate adjustment, patient characteristics that were associated with nursing home placement were as follows: black ethnicity (hazard ratio, 0.60; 95% confidence interval [CI], 0.48-0.74), Hispanic ethnicity (HR, 0.40; 95% CI, 0.28-0.56) (both ethnicities were inversely associated with placement), living alone (HR, 1.74; 95% CI, 1.49-2.02), 1 or more dependencies in activities of daily living (HR, 1.38; 95% CI, 1.20-1.60), high cognitive impairment (for Mini-Mental Status Examination score  20: HR, 1.52; 95% CI, 1.33-1.73), and 1 or more difficult behaviors (HR, 1.30; 95% CI, 1.11-1.52). Caregiver characteristics associated with patient placement were age 65 to 74 years (HR, 1.17; 95% CI, 1.01-1.37), age 75 years or older (HR, 1.55; 95% CI, 1.31-1.84), and high Zarit Burden Scale score (for highest quartile: HR, 1.73; 95% CI, 1.49-2.00). Patients were assigned to quartiles of risk based on this model. In the development cohort, patients in the first, second, third, and fourth quartile had a 25%, 42%, 64%, and 91% rate of nursing home placement at 3 years, respectively. In the validation cohort, the respective rates were 21%, 50%, 64%, and 89%. The C statistic for 3-year nursing home placement was 0.66 in the development cohort and 0.63 in the validation cohort.
Conclusions Patient and caregiver characteristics are both important determinants of long-term care placement for patients with dementia. Interventions directed at delaying placement, such as reduction of caregiver burden or difficult patient behaviors, need to take into account the patient and caregiver as a unit.
Author Affiliations: Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (Dr Yaffe), Department of Medicine (Drs Sands and Covinsky, Ms Lindquist, and Mr Dane), and the Institute for Health and Aging (Drs Fox and Newcomer), University of California, San Francisco; and the San Francisco Veterans Affairs Medical Center, Calif (Drs Yaffe and Covinsky).
RELATED LETTER
Nursing Home Placement and Dementia
Abhilash K. Desai, Kristine Yaffe, and Kenneth E. Covinsky
JAMA. 2002;288(6):696-697.
EXTRACT
| FULL TEXT
RELATED ARTICLE
April 24, 2002
JAMA. 2002;287(16):2153-2154.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Applying telecare in dementia: what psychiatrists need to know
Siotia and Simpson
Adv. Psychiatr. Treat. 2008;14:382-388.
ABSTRACT
| FULL TEXT
Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer's disease
Bruen et al.
Brain 2008;131:2455-2463.
ABSTRACT
| FULL TEXT
Dementia of the Alzheimer Type
Jalbert et al.
Epidemiol Rev 2008;0:mxn008v1-mxn008.
ABSTRACT
| FULL TEXT
Family physicians' perspectives on care of dementia patients and family caregivers
Yaffe et al.
cfp 2008;54:1008-1015.
ABSTRACT
| FULL TEXT
An Educational Intervention to Support Caregivers of Elders With Dementia
Devor and Renvall
AM J ALZHEIMERS DIS OTHER DEMEN 2008;23:233-241.
ABSTRACT
Emotional and Physical Health of Informal Caregivers of Residents at the End of Life: The Role of Social Support
Williams et al.
J. Gerontol. B Psychol. Sci. Soc. Sci. 2008;63:S171-S183.
ABSTRACT
| FULL TEXT
Why older people living with a spouse are less likely to be institutionalized: The role of socioeconomic factors and health characteristics
Nihtila and Martikainen
Scand J Public Health 2008;36:35-43.
ABSTRACT
Long-Term Adaptation to Institutionalization in Dementia Caregivers
Gaugler et al.
Gerontologist 2007;47:730-740.
ABSTRACT
| FULL TEXT
Impact of Adult Day Services on Behavioral and Psychological Symptoms of Dementia
Femia et al.
Gerontologist 2007;47:775-788.
ABSTRACT
| FULL TEXT
Efficacy of Behavioral Interventions for Dementia Caregivers
Farran et al.
West J Nurs Res 2007;29:944-960.
ABSTRACT
Light Treatment for Neuropsychiatric Behaviors in Alzheimer's Disease
Dowling et al.
West J Nurs Res 2007;29:961-975.
ABSTRACT
Treatment of Neuropsychiatric Symptoms in Patients with Dementia
Yaffe
NEJM 2007;357:1441-1443.
FULL TEXT
Clinical Diagnosis of Dementia, Not Behavioral and Psychologic Symptoms, Is Associated With Psychotropic Drug Use in Community-Dwelling Elders Classified as Having Dementia
Chan et al.
J Geriatr Psychiatry Neurol 2007;20:100-106.
ABSTRACT
Clinical Diagnosis of Dementia, Not Presence of Behavioral and Psychological Symptoms, Is Associated With Psychotropic Use in Community-Dwelling Elders Classified as Having Dementia
Chan et al.
J Geriatr Psychiatry Neurol 2007;20:50-57.
ABSTRACT
Envisioning better approaches for dementia care.
Covinsky and Johnston
ANN INTERN MED 2006;145:780-781.
FULL TEXT
Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease.
Mittelman et al.
Neurology 2006;67:1592-1599.
ABSTRACT
| FULL TEXT
Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review.
Ayalon et al.
Arch Intern Med 2006;166:2182-2188.
ABSTRACT
| FULL TEXT
Role of cholinesterase inhibitors in dementia care needs rethinking.
Pelosi et al.
BMJ 2006;333:491-493.
FULL TEXT
Effects of Donepezil on Neuropsychiatric Symptoms in Patients With Dementia and Severe Behavioral Disorders
Cummings et al.
AJGP 2006;14:605-612.
ABSTRACT
| FULL TEXT
Long-term-care placement and survival of persons with Alzheimer's disease.
McClendon et al.
J. Gerontol. B Psychol. Sci. Soc. Sci. 2006;61:P220-P227.
ABSTRACT
| FULL TEXT
Lower utilization of primary, specialty and preventive care services by individuals residing with persons in poor health.
Chaix et al.
Eur J Public Health 2006;16:209-216.
ABSTRACT
| FULL TEXT
Psychosocial Predictors of Dementia Caregiver Desire to Institutionalize: Caregiver, Care Recipient, and Family Relationship Factors
Spitznagel et al.
J Geriatr Psychiatry Neurol 2006;19:16-20.
ABSTRACT
Caregivers' Reasons for Nursing Home Placement: Clues for Improving Discussions With Families Prior to the Transition
Buhr et al.
Gerontologist 2006;46:52-61.
ABSTRACT
| FULL TEXT
The Value of Telephone Support Groups Among Ethnically Diverse Caregivers of Persons With Dementia
Bank et al.
Gerontologist 2006;46:134-138.
ABSTRACT
| FULL TEXT
Research and Care of Patients With Dementia: Moving Beyond Memory Loss
Yaffe
AJGP 2005;13:921-925.
FULL TEXT
Rivastigmine: An Open-Label Observational Study of Behavioral Symptoms Identified as Most Troubling by Caregivers of Patients With Alzheimer's Disease
Lilly and Farlow
J Am Psychiatr Nurses Assoc 2005;11:293-297.
ABSTRACT
Neuropsychiatric and behavioral alterations and their management in moderate to severe Alzheimer disease
Cummings
Neurology 2005;65:S18-S24.
FULL TEXT
Caregiver Psychological Adjustment and Institutionalization of Persons With Alzheimer's Disease
Gilley et al.
J Aging Health 2005;17:172-189.
ABSTRACT
Pharmacological Treatment of Neuropsychiatric Symptoms of Dementia: A Review of the Evidence
Sink et al.
JAMA 2005;293:596-608.
ABSTRACT
| FULL TEXT
Long-term Care Placement of Dementia Patients and Caregiver Health and Well-being
Schulz et al.
JAMA 2004;292:961-967.
ABSTRACT
| FULL TEXT
Supporting Family Caregivers at the End of Life: "They Don't Know What They Don't Know"
Rabow et al.
JAMA 2004;291:483-491.
ABSTRACT
| FULL TEXT
Home Care
Levine et al.
JAMA 2003;290:1203-1207.
FULL TEXT
Predictors of institutionalisation in people with dementia
Banerjee et al.
J. Neurol. Neurosurg. Psychiatry 2003;74:1315-1316.
ABSTRACT
| FULL TEXT
"At least Mom will be safe there": the role of resident safety in nursing home quality
Kapp
Qual Saf Health Care 2003;12:201-204.
ABSTRACT
| FULL TEXT
Management of Alzheimer's Disease
Grossberg and Desai
J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:M331-353.
FULL TEXT
The incremental direct costs associated with behavioral symptoms in AD
Murman et al.
Neurology 2002;59:1721-1729.
ABSTRACT
| FULL TEXT
Alzheimer Disease: "It's Okay, Mama, If You Want to Go, It's Okay"
Hurley and Volicer
JAMA 2002;288:2324-2331.
ABSTRACT
| FULL TEXT
Nursing Home Placement and Dementia
Desai et al.
JAMA 2002;288:696-697.
FULL TEXT
|
