Patterns and Predictors of Institutionalization in Community‐Based Dementia Patients

Objective: To investigate patterns and predictors of institutionalization in a community‐based sample of dementia patients. Setting: The Mayo Clinic Alzheimer's Disease Patient Registry (ADPR), a community‐based prospective registry. Patients: Two hundred seventy‐five participants, including 145 dementia patients and 130 controls on whom longitudinal follow‐up data was available. The mean ages were 79.9 and 78.8 years, and the mean Mini‐Mental State Examination (MMSE) scores at enrollment were 22.1 and 28.1 points for the demented cases and controls, respectively. Measures: Place of residence, marital status, number of direct support providers, global cognitive status, activities of daily living and instrumental activities of daily living were used in hazards modeling of institutionalization. Results: The results from our community‐based sample suggest a high rate of institutionalization for dementia patients. One‐half of the sample of dementia patients were institutionalized within 2.5 years of enrollment in our patient registry. Identified assistance providers were absent in a significant proportion (36%) of our dementia sample. Marital status, global cognitive function, and functional status were significant terms in hazards models of institutionalization. Age, gender, number of direct caregivers, and dementia etiology were not associated with significant risk. Seventy‐two percent of the dementia patients who died over the course of this study had been placed in nursing home care prior to death (with a mean length of stay of 2.8 years). Conclusions: Social (marital status) and disease‐related variables (cognitive and functional status) are related to risk for institutionalization. These variables may be useful in estimating time to institutionalization in various clinical and research populations. 1994 The American Geriatrics Society