Predictors of institutionalization for people with dementia living at home with a carer

OBJECTIVE: This article examines the relationships between behaviour, psychological functioning, the caring environment and subsequent institutionalization in patients with dementia living at home with a carer. DESIGN: Longitudinal study of behaviour in dementia, with a nested case-control study to investigate predictors of institutionalization. SETTING: Subjects with dementia, known to service, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: 100 people with dementia (Alzheimer's disease and/or vascular dementia) who were living at home with a carer at the start of the study. MEASURES: At 4-monthly intervals, the carers were interviewed and the subjects with dementia were assessed cognitively. Subjects' behaviour and psychological functioning were assessed using the Present Behavioural Examination. RESULTS: The characteristics which best predicted institutionalization 1 year later were: excessive night-time activity; immobility or difficulty in walking; incontinence; being away from a carer for more than 16 hours a week; and being cared for by a female. Aggressive behaviour was not associated with an increased chance of entry into an institution 1 year later, although it was more prevalent 4 months before entering an institution. CONCLUSIONS: Both behaviour and psychological functioning and the caring environment can help in predicting which patients with dementia currently living at home will enter an institution 1 year later. These predictors are not the same as those which are the immediate cause of institutionalization.