Risk Factors for Institutionalization Among the Elderly: A Systematic Literature Review

Abstract

Objective(s) To provide a systematic review of the risk factors for long-term institutionalization in older adults living in developed countries. Data Sources A systematic search of the following scholarly databases was conducted: PubMed, CINAHL, Web of Science, and Cochrane Library. Study Selection English language articles, with a primary or secondary outcome of institutionalization, published from January 2010 to September 2020 were identified. Studies assessing multivariate predictors for institutionalization among the elderly were included. Data Extraction Titles, abstracts, and full-text articles were independently reviewed by all authors to determine study eligibility. Data Synthesis A total of 1,358 studies were identified. Among eligible studies, 100 studies met the inclusion criteria. Consistent multivariate predictors for institutionalization were increased age, low education status, one or more comorbidities, functional and/or cognitive impairment, neurological/circulatory disorders (e.g., stroke), urological disorders (e.g., urinary incontinence), environmental factors (e.g., caregiver burden), and medical histories (e.g., emergency department visits). The female gender emerged as a predictor for institutionalization across disease groups such as stroke, chronic conditions, Alzheimer's Disease, and mood disorders, except for dementia. Race was a significant predictor of institutionalization only for dementia patients (White vs non-white). Conclusions Findings suggest that multivariate predictors for increased risk of institutionalization among older adults primarily stem from underlying cognitive and/or functional impairment, and associated environmental factors, such as caregiver burden or loneliness. Inconsistencies in race predicting institutionalization can be attributed to differences in study samples and methodological differences in racial group comparisons, and variation observed in female risk for institutionalization is possibly influenced by gender socialization and physiological differences. Author(s) Disclosures All authors report no financial relationships or financial conflicts of interest. To provide a systematic review of the risk factors for long-term institutionalization in older adults living in developed countries. A systematic search of the following scholarly databases was conducted: PubMed, CINAHL, Web of Science, and Cochrane Library. English language articles, with a primary or secondary outcome of institutionalization, published from January 2010 to September 2020 were identified. Studies assessing multivariate predictors for institutionalization among the elderly were included. Titles, abstracts, and full-text articles were independently reviewed by all authors to determine study eligibility. A total of 1,358 studies were identified. Among eligible studies, 100 studies met the inclusion criteria. Consistent multivariate predictors for institutionalization were increased age, low education status, one or more comorbidities, functional and/or cognitive impairment, neurological/circulatory disorders (e.g., stroke), urological disorders (e.g., urinary incontinence), environmental factors (e.g., caregiver burden), and medical histories (e.g., emergency department visits). The female gender emerged as a predictor for institutionalization across disease groups such as stroke, chronic conditions, Alzheimer's Disease, and mood disorders, except for dementia. Race was a significant predictor of institutionalization only for dementia patients (White vs non-white). Findings suggest that multivariate predictors for increased risk of institutionalization among older adults primarily stem from underlying cognitive and/or functional impairment, and associated environmental factors, such as caregiver burden or loneliness. Inconsistencies in race predicting institutionalization can be attributed to differences in study samples and methodological differences in racial group comparisons, and variation observed in female risk for institutionalization is possibly influenced by gender socialization and physiological differences.