• Smith, Glenn E (PI)

Project: Research project

Project Details


In 1985 1.3 million people were residing in nursing homes with costs of
institutional care exceeding the direct medical costs of home care by as
much as $11,000 per patient-year. Yet the factors contributing to
institutionalization of dementia patients are not clearly understood.' The
present study will undertake four related objectives. The first is to
determine the cumulative incidence of institutionalization in population-
based cohorts of dementia patients and their matched controls. The second
is to determine risk for institutionalization of dementia patients
associated with a) demographic factors, b) co-morbid illness c) non-
nursing home health' care utilization and d) factors specific to the
dementing illness. The third Objective is to determine the frequency with
which institutionalization is initiated by family members versus health
care professionals. The fourth objective is to distinguish between the
presence of deteriorated functional status and caregivers' abilities to
tolerate these impairments. Each of these aims has relevance for public
policy and care innovations for dementia patients. The present study will
capitalize on the Mayo Clinic Alzheimer's Disease Patient Registry (ADPR)
and emulate the existing scheme of the ADPR in having retrospective and
prospective components. The retrospective sample is population-based and
includes 662 dementia patients with onset of dementia occurring between
1975-1984 and 662 age- and sex-matched controls. The medical records of
cases and controls in 1975-1979 and 1980-1984 retrospective cohorts will
be abstracted to determine the date and place of nursing home placement.
Because of the medical records-linkage system at the Mayo Clinic these
records are complete for all Olmsted County, MN patients. Rates of nursing
home placement within the dementia sample will be calculated. Hazards
models for placement associated with various demographic factors and an
index of co-morbid illness will be calculated. The prospective sample is
community-based and currently includes 536 matched pairs of dementia
patients and controls. Data regarding residence will be collected during
ADPR longitudinal follow-up procedures. Participants will be seen in their
residence at follow-up so that place of residence will be determined by
direct observation. Disease specific variables including cognitive status,
functional status and behavioral disturbance will be integrated with co-
morbidity and demographic data to develop hazards models for
institutionalization in the prospective sample. Understanding which
features of dementing disease processes are most directly related to
institutionalization is a necessary precursor to intervention strategies
seeking to delay or prevent the need for institutionalized care.
Effective start/end date9/30/938/31/99


  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health
  • National Institutes of Health


  • Medicine(all)


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