Abstract
BackgroundThere is a lack of evidence on the contribution of mild cognitive impairment (MCI) to institutionalization in older adults. This study aimed to evaluate a range of risk factors including MCI of institutionalization in older men.MethodsMen aged ≥70 years (n = 1705), participating in the Concord Health and Ageing in Men Project, Sydney, Australia were studied. Participants completed self-reported questionnaires and underwent comprehensive clinical assessments during 2005–2007. Institutionalization was defined as entry into a nursing home facility or hostel at any time over an average of 5 years of follow-up. Cox regression analysis was conducted to generate hazard ratios (HR) with 95% confidence intervals (CI).ResultsA total of 125 (7.3%) participants were institutionalized. Piecewise Cox proportional models were generated and divided at 3.4 years (1250 days) of follow-up due to violation of the proportional hazards assumption for the association between MCI and institutionalization (χ2 = 6.44, p = 0.01). Dementia, disability in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), poor grip strength, few social interactions, being a Non-English speaking immigrant and age were predictive of institutionalization during both time periods, whereas MCI (HR = 4.39, 95%CI 2.17–8.87) only predicted institutionalization in the period beyond 3.4 years of follow-up. Being married (HR = 0.42, 95%CI: 0.24–0.72) was protective only during the period after 3.4 years of follow-up.DiscussionIn this study, the strongest predictors of institutionalization were dementia, MCI, ADL and IADL disability. MCI was not a predictor of early institutionalization but became a significant predictor beyond 3.4 years of follow-up.
Highlights
Delaying older adults’ transition from living in the community to institutionalization is of major public health importance
The multivariate Cox proportional model showed that age, marital status, social satisfaction, social interactions, country of birth, alcohol use, cognitive status, Activities of Daily Living (ADL) disability, Instrumental Activities of Daily Living (IADL) disability, grip strength, and service use were significant predictors of institutionalization
The use of a time-dependent covariate and analysis of Schoenfeld residuals demonstrated that mild cognitive impairment (MCI) violated the proportional hazards assumption (x2 = 6.44, p = 0.01)
Summary
Delaying older adults’ transition from living in the community to institutionalization is of major public health importance. Population-based and dementia-based samples) have investigated risk factors for institutionalization in older adults [1,2]. While most studies that have investigated predictors of institutionalization have looked at severe cognitive impairment, the contribution of mild cognitive impairment (MCI) to institutionalization in older adults is not clear. One study has looked at the association of cognitive impairment not including dementia with adverse outcomes including institutionalization in older adults [5]. There is a lack of evidence on the contribution of mild cognitive impairment (MCI) to institutionalization in older adults. This study aimed to evaluate a range of risk factors including MCI of institutionalization in older men
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