Which elder is most likely to be institutionalized

The sample size used in our study was limited, which may prevent us from making broad generalizations. Furthermore, the study was conducted through face-to-face interviews, which might create a possibility of asking bias. The authors declare that they have no known conflict personal interests that could have appeared to influence the work reported in this paper.

MD conceived the study, methodology, and formal analysis and wrote the original draft; SD conceived the study, methodology, and formal analysis and wrote the original draft; SK did the validation and formal analysis and conceived the software; KB did the validation, formal analysis, and writing of the original draft; SM did the writing, reviewing, and editing.

All authors read and approved the final manuscript. Equal contributions must be considered as the combined first author.

The authors would like to acknowledge Dr. Liliana Giraldo-Rodriguez and Prof. We extend our gratitude to Prof. Jerome A. Yesavage and Prof. Javaid I. Sheikh for developing the item Geriatric Depression Scale. Furthermore, we are immensely grateful to the elderly who dedicated their time to participate in our study and the authorities at the old age homes for their cooperation.

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Academic Editor: Andrzej Pilc. Received 06 Feb Revised 19 Apr Accepted 21 Apr Published 29 Apr Abstract Background. Materials and Methods A descriptive cross-sectional quantitative study was carried in 5 randomly selected old-age homes out of 11 old age homes of Kathmandu Valley of Nepal. The sample size was first calculated for the infinite population and then for the finite population using the formulas below: where size for infinite population, , , , and Using the formula, the sample sizes for the infinite population were found to be The sample size was then calculated for the finite population using the following formula: where size for finite population, size for infinite population, and estimated number of elderly living in old age homes obtained through the Social Welfare Council : To avoid any missing data, the sample size taken for this study was Results In Table 1 , among a total of respondents, the mean and SD age of the respondents was years and Table 1.

Demographic characteristics of the respondents. Statistical significance. Table 2. Binary regression analysis of factors associated with types of abuse. Table 3. Table 4. Multinomial regression analysis of factors associated with depression. Krug, L.

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The correlates of caregiver burden are summarized in Table 2. In the multivariate analysis, only the behavior disturbance and the caregiver's depressive mood were significantly associated with caregiver burden as measured by the ZBI with similar partial correlation coefficients of 0.

The factors associated with the desire to institutionalize are presented in Table 3. In the multivariate analysis, the following variables were independently associated with an increased risk: moderate or severe dementia adjusted odds ratio: 2.

Compared to previous studies, this study has many strengths. The data come from a population-based survey generating a representative sample of community-dwelling elderly people with dementia and their caregivers.

Both patients and their caregivers were assessed using standardized instruments, leading to precise measurement of many variables thought to be associated with institutionalization. It must be acknowledged, however, that this study was carried out in Canada in the context of a public and universal health care system that includes coverage for long-term care institutions. Thus the generalizability of the results to other health care systems is not guaranteed. In this study, the median time to institutionalization was 41 months, which is very similar to that of previous studies by Heyman and colleagues 20 ; around 42 months , Drachman and colleagues 21 ; 39 months and O'Donnell and colleagues 22 ; more than 36 months.

The present study also confirms other results that institutionalization is related more to the severity of disabilities experienced by the subjects with dementia 20 23 24 25 26 27 28 29 30 than to the severity of dementia or cognitive impairment. This is surprising given that Alzheimer's disease is associated with longer survival than vascular dementia and that there are well-structured support organizations dedicated to subjects with Alzheimer's disease and their caregivers as opposed to other types of dementia.

The fact that the risk for institutionalization was significantly higher in three regions of Canada than in Ontario and the Atlantic provinces is striking. This can be related to the availability of home-care services and long-term care beds. Also, the Atlantic provinces and Ontario showed a lower rate of institutionalized elderly people 6. This study confirms that caregiver burden is a strong predictor of institutionalization 28 30 33 34 35 36 37 The ZBI used in this and other previous studies 30 33 34 appears to be a good screening instrument for clinicians to identify caregivers at risk of giving up the home care of their family members with dementia.

The shorter item version proposed previously 16 showed the same HR 1. Older caregivers were more at risk for giving up home care as previously reported by Nygaard The fact that having a spouse as caregiver is a protective factor from institutionalization was also found by Colerick and George 39 and Scott 25 and is probably explained by the emotional link between the caregiver and the care-receiver.

According to our data, the same is true for being a child as opposed to Scott's study that showed a significant risk for the parent adjusted odds ratio: 4.

Poor physical health of the caregiver is also an important short-term risk factor and this confirms the findings of previous studies 33 Caregiver burden was more strongly correlated with the depressive mood of the caregiver and the behavior problems of the subjects with dementia than to cognitive or functional impairments or the severity of the dementia.

This is consistent with most previous studies 30 40 41 42 43 and with studies that have shown that the psychological problems of the caregivers are more strongly associated with behavior problems than with functional or cognitive impairments The intermediate role of the desire to institutionalize is consistent with many studies that showed that this variable is a short-term predictor of institutionalization 34 36 45 and other studies reporting that this variable is associated with the severity of cognitive impairment 46 , the caregiver's burden 34 46 , and the utilization of services When these three sets of analyses are considered together, we can propose the model summarized in Fig.

That is, institutionalization is determined by the type of dementia i. Burden itself is often the result of behavior problems and is associated with the caregiver's depressive mood.

The desire to institutionalize is related to the severity of dementia, the fact that the dementia sufferer cannot be left alone and that the caregiver lives with him or her, the caregiver burden, and the use of two or more home care services.

In conclusion, this study identified risk factors for institutionalization that should be considered in the assessment of patients with dementia, namely: severity of disabilities, Alzheimer's disease, old age of caregivers, no first-degree kinship of the caregiver with the patient, and poor health of the caregiver.

The caregiver's burden, depressive mood, and desire to institutionalize should be assessed because they are strong predictors amenable to modification by specific interventions targeted especially toward managing the behavior problems of the dementia sufferers and treating the depressive mood of the caregivers Has thought about it somewhat seriously, has discussed it with someone, or has visited an institution.

Flow of subjects in the study Canadian Study of Health and Aging, — Kaplan-Meier survival curve of the time to admission to an institution adjusted for activities of daily living rating Canadian Study of Health and Aging, — Proposed model of the risk factors associated with long-term institutionalization of older subjects with dementia.

The data reported in this article were collected as part of the Canadian Study of Health and Aging. Additional funding was provided by Pfizer Canada Inc. The results reported in this article were presented at the Annual Meeting of the Canadian Association of Gerontology Ottawa, November Canadian Study of Health and Aging: study methods and prevalence of dementia. Can Med Assoc J. Net economic costs of dementia in Canada. Dementia caregiver burden: a review of the literature and guidelines for assessment and intervention.

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The imputation of missing dates of death or institutionalization for time-to-event analysis in the Canadian Study of Health and Aging. Int Psychogeriatr Suppl. In press. Collett D, Part XVII. The prognosis in Alzheimer's disease. Arch Neurol. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol. The reduction in the body mass and loss of muscle tone are characteristics involved in aging process and these factors imply in the reduction of movements, decrease of functional performance and induction of frailty [ 38 , 39 ].

The lack of physical stimulation in institutions increases the probability of functional disorders in elderly, which affects their HRQoL [ 40 ].

A previous study has demonstrated that lower levels of physical activity were associated with institutionalization [ 41 ]. In our study, none of the institutions investigated presented a regular program of physical activities for the elderly and this fact may be related to the reduced number of employees. In general, institutions have small number of professionals that are required to perform many functions, including the practice of regular physical activities among elderly.

Other studies emphasize malnutrition is related to functional disability and frailty, as result of muscle strength decrease and reduction of cardiorespiratory performance [ 45 , 46 ]. Poor nutritional status frequently accelerates the onset of frailty and predisposes elderly people to chronic diseases [ 48 ]. Therefore, frail elderly must be subjected to nutritional supplementation and physical activities in order to improve functional performance, nutritional status and the overall HRQoL [ 49 ].

We detected that None physical exercise programs were observed within the institutions visited in our study. Nevertheless, valid interventions for community-dwelling older adults are not necessarily valid for nursing home populations, since institutionalized elderly have higher rates of disability, multiple morbidities, and geriatric syndromes [ 49 ]. Depression is the most prevalent functional mental disorder in elderly people. It is projected that depressive illness will be the second leading cause of disability worldwide in [ 56 ].

The degree of unhappiness and suffering in people with depression is not easily measured, although one possible way is to assess the impact of depression on their quality of life. Even minor levels of depression have been related to a significant quality of life decrease among elders [ 57 ]. The results of this survey showed that depression status was associated with lower HRQoL among institutionalized elders. Developing programs for psychological monitoring and depression prevention are therefore necessary.

This would aid reducing the negative effects of depression on HRQoL. Although GDS is not a valid instrument for diagnosing depression, it has an excellent applicability in long-terms care institutions. GDS can contribute to monitoring the prevalence of symptoms related to depression [ 58 ]. The relationship between depression and poor quality of life perception among elders has been demonstrated previously [ 59 ]. The loss of independence and privacy within long-term care institutions can aggravate the depression status among institutionalized elders [ 41 ].

Psychological illness is usually associated with lower life enjoyment and demotivation, which implies in lower functional capacity and lower quality of life [ 59 ]. The oral health of institutionalized elderly was previously characterized by high frequency of tooth loss, lack of regular preventive care and lack of dental treatment [ 60 , 61 ].

This illustrates that oral health is undervalued among institutionalized elders. Therefore, the self-perceived oral health does not seem to impact the HRQoL of institutionalized elders. It is important to consider this is a cross-sectional study and statistically significant associations may not always represent a cause-effect relationship.

Although the sample size can be considered limited, this was set by a statistical calculation and it represents the whole number of institutionalized elderly that could answer the validated questionnaires with certain level of reliability. The results of this study can be set as representative of institutions from the capital cities of Brazil Northeast, as well as other countries with similar economical status or long term care institutions structure.

Results of this study could aid institutions to promote physical and psychological interventions to prevent frailty and depression among institutionalized individuals. In our study, retired, frail and depressed institutionalized elders presented a higher chance to have worse HRQoL. These findings emphasize the need to plan and implement strategies to impact significantly the HRQoL of institutionalized elders.

In addition, the inclusion of physical activities programs and recreational activities may contribute positively to the recovery of the physical and mental states of these individuals, allowing them to live with dignity and better quality of life.

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