Why Family Caregivers Choose to Institutionalize a Loved One with Dementia: A Singapore Perspective

Abstract

Aim: To examine factors associated with family caregivers’ choice of care setting (own home vs. nursing home) for their relatives with dementia. Methods: Cross-sectional study involving caregivers recruited from a tertiary hospital dementia clinic and the local Alzheimer’s association. Caregivers completed a questionnaire containing demographics of the person with dementia (PWD) and caregiver, their choice of care setting and the following scales: Gain in Alzheimer Care Instrument, General Health Questionnaire, Short Sense of Competence Questionnaire, Revised Memory and Behavioral Problems Checklist and Zarit Burden Interview. Multiple logistic regression was performed to identify significant variables associated with the outcome of interest. Results: The final sample comprised 266 caregivers, the majority of whom were Chinese, female and children of PWD. Most (85.7%) preferred care at home, only 38 (14.3%) chose institutionalization. Four factors were associated with choice of nursing home: caregiver working (OR = 6.363, 2.120–19.086), no domestic maid (OR = 3.27, 1.458–7.331), lower caregiver gain (OR = 0.935, 0.882–0.992) and behavioral problems in PWD (OR = 1.011, 1.005–1.018). Conclusion: Strategies to minimize institutionalization must first address the provision of a dedicated caregiver at home. Consequently, interventions to help caregivers cope with behavioral problems in PWD and enhance caregiver gain are relevant.