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Due to increased life expectancy and demographic ageing an increasing number of elderly people have to spend the eve of their life in institutional settings, which is often associated with adverse psychosocial and financial consequences. The purpose of this prospective study is to assess the extent and determinants of institutionalization in a population sample of severely disabled elderly people from south Germany. The study population included all non-institutionalized persons in a defined region who met the criteria of permanent nursing dependency set by the German statutory health insurance system. Study participants were recruited in 1991–1993 and followed for a mean of 1.7 years. Rate ratios of Institutionalization for potential risk factors were calculated using Cox's proportional hazards model. Out of 1,583 study participants 159 aged 60 years or older were admitted to a nursing home during the follow-up period. Old age, female gender, living In urban compared to rural areas, professional provider of nursing care compared to family members as main care givers and cognitive impairments independently increased the rate of institutionalization In multivariable analysis. There was no relationship between limitations in basic activities of daily living and the rate of institutionalization. These empirical data extend the scarce database in Germany, which is needed for further planning of nursing care facilities in the community in order to improve the situation of disabled people, in particular to prevent nursing home admission.
Ulrike Kliebsch (Mon,) studied this question.