Factors associated with long-term institutionalization of older people with dementia: Data from the Canadian study of health and aging

Background. In Canada, half the people with dementia live in institutions. Factors associated with institutionalization should be identified with the goal of implementing strategies not only to permit those with dementia to s tay in their homes as long as is feasible but also to ensure that steps are taken for timely institutionalization when appropriate. Methods. Informal caregivers of 326 individuals with dementia living in the community were identified and interviewed as part of the Canadian Study of Health and Aging (CSHA). These subjects were contacted again 2.5 and 5 yea rs after the baseline interview to collect information on the status of the ir care recipients. Survival analyses using clinical data for the individua ls with dementia and data from the interviews with their informal caregiver s were carried out using Cox proportional hazard modeling to estimate the h azard ratio (HR). Results. Over the 5-year period, 166 individuals with dementia (50.9%) were institutionalized and the median time to admission was 41 months. From the multivariate analysis, the factors significantly associated with instituti onalization were: type of dementia (Alzheimer's disease: HR = 1.83), severi ty of disability (mild: 1.51; moderate: 2.34; total impairment: 4.02), care giver's age over 60 (1.83), caregiver not a spouse or child (1.55), and sev ere caregiver burden (1.71). Caregiver's burden was associated with the car e-receiver's behavioral disturbance (partial r = .55) and the caregiver's d epressive mood (r = .55). Conclusions. Screening caregivers for burden and depression and designing i nterventions to decrease the consequences of behavioral disturbance on care givers would be relevant avenues to explore to decrease institutionalizatio n of people with dementia.