Nursing Home Admission in Elderly Subjects With Dementia: Predictive Factors and Future Challenges

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• 作者：Moustapha Dramé ; MD ; MPH ; PhD^a ; ^b ; ^{mdrame@chu-reims.fr} ; Pierre-Olivier Lang ; MD ; MPH ; PhD^a ; ^c ; Damien Jolly ; MD ; MPH ; PhD^a ; ^d ; David Narbey ; PharmD^a ; Rachid Mahmoudi ; MD^a ; ^b ; Isabelle Laniè ; ce ; MD ; MPH^e ; Dominique Somme ; MD ; MPH ; PhD^f ; Jean-Bernard Gauvain ; MD^g ; Damien Heitz ; MD^h ; Thierry Voisin ; MD ; PhDⁱ ; Benoî ; t de Waziè ; res ; MD ; PhD^j ; Ré ; gis Gonthier ; MD ; PhD^k ; Joë ; l Ankri ; MD ; MPH ; PhD^l ; Olivier Saint-Jean ; MD ; PhD^f ; Claude Jeandel ; MD ; PhD^m ; Pascal Couturier ; MD ; MPH ; PhD^e ; Franç ; ois Blanchard ; MD ; MPH ; PhD^a ; ^b ; Jean-Luc Novella ; MD ; MPH ; PhD^a ; ^b
• 关键词：Elderly ; institutionalization ; dementia ; demographic changes ; SAFES cohort
• 刊名：Journal of the American Medical Directors Association
• 出版年：2012
• 出版时间：January, 2012
• 年：2012
• 卷：13
• 期：1
• 页码：83.e17-83.e20
• 全文大小：127 K

文摘

Objectives

The aim of this study was to identify factors predictive of nursing home admission (NHA) over a period of 1 year among elderly subjects with dementia.

Methods

The study population was drawn from the SAFES cohort that was formed within a national research program into the recruitment of emergency departments in 9 teaching hospitals. Subjects were to have been hospitalized in a medical ward in the same hospital as the emergency department to which they were initially admitted. Subjects who experienced NHA before emergency department admission were excluded. Those with a confirmed diagnosis of dementia were considered in the present analysis. NHA has been defined as the incident admission into either a nursing home or other long term care facility within the follow-up period. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 1-year NHA.

Results

The 425 subjects of the study were 86 ¡À 6?years old, and were mainly women (63 % ). NHA rate was 40 % (n?= 172). Four factors were identified to increase NHA risk: age 85 or older (hazard ratio [HR]?= 1.5; 95 % confidence interval [CI]?=?1.1-2.1), inability to use the toilet (HR?= 2.5; 95 % CI?= 1.5-4.2), balance disorders (HR?= 1.5; 95 % CI?= 1.1-2.1), and living alone (HR?= 1.5; 95 % CI?=?1.1-2.1). Three factors decreased this risk significantly: inability to transfer (HR?= 0.5; 95 % CI?= 0.3-0.8), increased number of children (HR?= 0.88; 95 % CI?= 0.96-0.99), and increased initial Mini-Mental State Examination score (HR?= 0.97; 95 % CI?= 0.8-0.9).

Conclusion

NHA determinants in dementia are strongly linked to the patient¡¯s own characteristics but also to his or her physical or social environment. Interventions should target both members of the dyad ¡°patient-caregiver¡± because both are affected by the disease.