Prospective analysis of risk factors for nursing home placement of dementia patients

Objective: To examine risk factors for nursing home placement in a communit y-based dementia cohort. Methods: Cognitively normal participants and cogni tively impaired patients from a large AD Patient Registry were followed fro m diagnosis to placement, death, or last follow-up. This included over 3,60 0 person-years of surveillance. The normal group included 473 participants who did not, at any point, meet Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised (DSM-III-R) criteria for dementia. The patient group included 512 patients who met DSM-III-R criteria for dementia or cri teria for mild cognitive impairment at diagnosis. Demographic, medical, soc ial, cognitive, behavioral, and functional predictors of time to placement were examined using Cox modeling. Results: In the normal group, only 21 peo ple (4%) required nursing home placement. With subjects, enrollment year, a ge at initial evaluation, being widowed, and living in a retirement communi ty were associated with time to placement in separate univariate analyses. Of 512 cognitively impaired patients, 203 (39.6%) were placed in nursing ho mes. Median time from diagnosis to placement was 5.3 years. Within the pati ent sample, four predictors were determined to be associated with time to n ursing home placement. These included gender, enrollment year, functional s tatus, and cognitive score. Interactions were present for functional status with cognitive score and enrollment year. Conclusion: In patients with dem entia who are within 5 years of diagnosis, placement rates of approximately 10% per year can be expected. Disease severity indices including degree of cognitive and functional impairment are primary risk factors for placement .