Institutionalization risk amongst people with dementia supported by family carers in a Scottish city

Abstract

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-demented older people to determine the factors predictive of institutionalization. We interviewed elders and carers for presence and severity of dementia, characteristics of elder and carer, service use, and carers' perceptions of needs and attitudes to care. Subjects were followed up over a 2-year period. Eleven demented and 10 non-demented elders were lost to follow-up. Forty-nine of 103 demented and 7 of 104 non-demented elders were institutionalized. Demented elders were 8.21 times more 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 6, RR 5.67, 95% CI 1.47-21.88) and carers' willingness to continue caring (willing vs totally willing RR 4.46, 95% CI 1.41-14.10). Our study confirms the high risk of institutionalization amongst demented older people. Early institutionalization of demented elders can be predicted and should be planned for, to help elders and carers cope with the process of adjustment. Where carers are totally committed to continuing care, intensive community support may be required for problems associated with advanced dementia.