INSTITUTIONALIZATION RISK AMONGST PEOPLE WITH DEMENTIA SUPPORTED BY FAMILY CARERS IN A SCOTTISH CITY

We studied 114 community-resident demented older people living at home with the support of a family carer and a matched sample of 114 non-de mented older people to determine the factors predictive of institution alization. We interviewed elders and carers for presence and severity of dementia, characteristics of elder and carer, service use, and care rs' perceptions of needs and attitudes to care. Subjects were followed up over a 2-year period. Eleven demented and 10 non-demented elders w ere lost to follow-up. Forty-nine of 103 demented and 7 of 104 non-dem ented elders were institutionalized. Demented elders were 8.21 times m ore likely to be institutionalized than non-demented elders, adjusting for age and sex (95% CI 3.69-18.23). Using Cox's Proportional Hazards Model, factors which predicted institutionalization amongst demented elders were: Mini Mental State Examination Score (RR 0.87, 95% CI 0.80 -0.96), carers' perceived problems in relation to the elders' physical disabilities (need for 1-3 hours per week vs no need, RR 6.10, 95% CI 2.34-15.89), behavioural problem score (7-13 vs less than or equal to 6, RR 5.67, 95% CI 1.47-21.88) and carers' willingness to continue ca ring (willing vs totally willing RR 4.46, 95% CI 1.41-14.10). Our stud y confirms the high risk of institutionalization amongst demented olde r people. Early institutionalization of demented elders can be predict ed and should be planned for, to help elders and carers cope with the process of adjustment. Where carers are totally committed to continuin g care, intensive community support may be required for problems assoc iated with advanced dementia.