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

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Abstract
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. Copyright© 1998 John Wiley & Sons, Ltd.