Predictors of Institutionalization in Patients with Alzheimer's Disease

Abstract

Dementia is the most frequent reason for the institutionalization in the elderly. Knowing the estimated time until institutionalization can give important information to clinicians and caregivers in making decisions. Many studies have reported predictors of institutionalization in patients with dementia, but only few studies have included the factors that measured long-term change. Moreover, studies with Asian population are scarce. In this study, we first evaluated baseline factors that may predict institutionalization of the patient with Alzheimer’s disease, and then we evaluated predictors that measured longitudinal change.

Among the patients with Alzheimer’s disease enrolled in CREDOS study, we selected the patients who were enrolled between July 2008 and December 2013, to utilize data from public long-term care insurance, which has been implemented in South Korea since July 2008. We excluded the patients who have already been institutionalized at the time of enrollment. By retrospectively reviewing the data from the long-term care insurance program, we identified the patients who were institutionalized between July 2008 and January 2014. We compared the measures of dementia severity, cognition, neuropsychiatric symptoms, and medication use between the institutionalized patients and not-institutionalized patients.

On mean 3.19 years of follow-up, 421 (17%) of patients were institutionalized. Institutionalized patients were less educated, had longer duration after onset of the symptoms, and had lower cognitive ability, higher dementia severity, and more severe neuropsychiatric symptoms at baseline. They had more rapid decline of cognitive ability and aggravation of dementia severity. The institutionalized patients also used the antipsychotics more frequently. Finally, lower cognitive at baseline, higher dementia severity at baseline, more severe neuropsychiatric symptoms at baseline, more rapid aggravation of dementia severity, and more frequent use of antipsychotics were independent predictors of institutionalization.