Risk factors for nursing home placement in a population-based dementia cohort

OBJECTIVE: To examine risk factors for nursing home placement in a populati on-based dementia cohort. METHODS: The Mayo Clinic Medical Records linkage system was used to identif y all patients with onset of dementia between 1980 and 1984. The patient gr oup included 314 cases who met DSM-III-R criteria for dementia, including 2 20 cases who were community dwelling at onset. All dementia patients were f ollowed until death. A control group included 323 patients who did not, at any point, meet DSM-III-R criterion for dementia. The groups were initially matched on age, gender, and year of initial registration. Demographic, med ical, social, and functional predictors were examined as static and time-de pendent risk factors for nursing home placement in the initial community-dw elling subgroups, using stepwise Cox regression modeling. RESULTS: Of the 314 dementia patients, 282 took residence in licensed skill ed nursing homes for at least 6 weeks, suggestive of custodial care, at som e point during the course of their illness. In the control group, 162 of th e 323 people required nursing home placement. Within controls, the predicto r variables of time to nursing home placement included initial age, being d ivorced, living in a townhome, apartment or assisted living apartment, chan ge in Charlson comorbidity score, and change in amount of daily assistance required. Within the dementia sample, seven predictors were eventually dete rmined to be associated with time to nursing home placement. These included total number of years of education, age at onset of dementia, being single , living in a retirement or supervised apartment at onset, change in Charls on comorbidity score, and a change in the amount of daily assistance requir ed. CONCLUSIONS: Cumulative incidence of placement was 90% in the dementia coho rt and 50% in the controls. Certain variables seem to impact time to nursin g home placement in all older persons, whether they have dementia or not. A mong these are age, living in assisted living settings, increasing comorbid ity scores, and increasing need for functional assistance. Certain addition al factors may have a specific impact in dementia. Among these is education , which seems to provide a protective effect. These predictors may be impor tant covariates in clinical dementia studies that include time to nursing h ome placement as an outcome variable.