Modeling time to institutionalization in dementia

The purpose of this study was to identify predictors of time to institutionalization over a 3-year period. The sample included 3,944 persons with dementia who resided in eight catchment areas in the U.S. A Cox proportional hazards model was constructed that considered care recipient demographics, caregiver demographics, and time-varying measurements of care recipient functional status, caregiving indicators, and service utilization. Although dimensions such as patient function were key triggers of expedited institutionalization, of interest was the prominence of caregiving indicators (i.e., burden, self-rated health) and community-based service use as significant predictors of earlier placement. Change in caregiver IADLs and care recipient ADLs also appeared to facilitate institutionalization. The findings emphasize the importance of incorporating measures of care recipient function, caregiver well-being, and community-based service in concert when designing and implementing clinical interventions to delay nursing home placement for persons with dementia.