Volume 7, Issue 1, March 2019, Page: 12-18
Community Services, Progression Rate, and Nursing Home Placement In Persons with Alzheimer’s Disease
Jocelyn Shealy McGee, Garland School of Social Work, Baylor University, Waco, Texas, USA
Dennis R. Myers, Garland School of Social Work, Baylor University, Waco, Texas, USA
Haley Groce, Garland School of Social Work, Baylor University, Waco, Texas, USA
Received: Mar. 22, 2019;       Accepted: May 15, 2019;       Published: Jun. 12, 2019
DOI: 10.11648/j.ajpn.20190701.13      View  42      Downloads  6
There are many factors influencing when a person with Alzheimer’s disease (AD) or another dementia is placed in a nursing home (NHP). The aims of this study were to determine if introducing home and community-based services (HCBS) at different stages of disease severity influenced time to NHP in a sample of persons living with AD (n = 1210); examine if disease pre-progression rate (PPR) influenced time to NHP; and explore the interaction between disease severity at first use of HCBS and PPR on time to NHP. Findings suggested that earlier introduction of HCBS delayed time to NHP in a univariate model (p = 0.03), but not when covariates were adjusted (p = 0.39); faster PPR resulted in earlier NHP in both univariate (p < 0.001) and covariate adjusted models (p < 0.01); and earlier introduction of HCBS delayed time to NHP (even when PPR was taken into consideration). Implications are discussed.
Dementia, Alzheimer’s, Nursing Home Placement, Community Services
To cite this article
Jocelyn Shealy McGee, Dennis R. Myers, Haley Groce, Community Services, Progression Rate, and Nursing Home Placement In Persons with Alzheimer’s Disease, American Journal of Psychiatry and Neuroscience. Vol. 7, No. 1, 2019, pp. 12-18. doi: 10.11648/j.ajpn.20190701.13
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Alzheimer's Association. 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia. 2018; 14 (3): 367-429. doi: 10.1016/j.jalz.2018.02.001.
Alzheimer's Disease International. World Alzheimer report 2018. Alzheimer's Disease International. https://www.alz.co.uk/research/world-report-2018. Published September 2018.
Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. New England Journal of Medicine. 2013; 368 (14): 1326-1334. doi: 10.1056/nejmsa1204629.
Robison J, Shugrue N, Fortinsky RH, Gruman C. Long-term supports and services planning for the future: implications from a statewide survey of baby boomers and older adults. The Gerontologist. 2013; 54 (2): 297-313. doi: 10.1093/geront/gnt094.
Eaker ED, Vierkant RA, Mickel SF. Predictors of nursing home admission and/or death in incident Alzheimer’s disease and other dementia cases compared to controls. Journal of Clinical Epidemiology. 2002; 55 (5): 462-468. doi: 10.1016/s0895-4356 (01) 00498-x.
Callahan CM, Arling G, Tu W, et al. Transitions in care for older adults with and without dementia. Journal of the American Geriatrics Society. 2012; 60 (5): 813-820. doi: 10.1111/j.1532-5415.2012.03905.x.
Gaugler JE, Duval S, Anderson KA, Kane RL. Predicting nursing home admission in the U. S: a meta-analysis. BMC Geriatrics. 2007; 7 (1): 1-14. doi: 10.1186/1471-2318-7-13.
Gaugler JE, Yu F, Krichbaum K, Wyman JF. Predictors of nursing home admission for persons with dementia. Medical Care. 2009; 47 (2): 191-198. doi: 10.1097/mlr.0b013e31818457ce.
Miller EA, Weissert WG. Predicting elderly people’s risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Medical Care Research and Review. 2000; 57 (3): 259-297. doi: 10.1177/107755870005700301.
Nygaard HA, Albrektsen G. Risk factors for admission to a nursing home: a study of elderly people receiving home nursing. Scandinavian Journal of Primary Health Care. 1992; 10 (2): 128-133. doi: 10.3109/02813439209014049.
Wingard DL, Jones DW, Kaplan RM. Institutional care utilization by the elderly: a critical review. The Gerontologist. 1987; 27 (2): 156-163. doi: 10.1093/geront/27.2.156.
Yaffe K, Patrick F, Newcomer R, et al. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA. 2002; 287 (16): 2090-2097. doi: 10.1001/jama.287.16.2090.
Heyman A, Peterson B, Fillenbaum G, Pieper C. Predictors of time to institutionalization of patients with Alzheimer’s disease: the CERAD experience, part XVII. Neurology. 1997; 48 (5): 1304-1309. doi: 10.1212/wnl.48.5.1304.
Knopman DS, Kitto J, Deinard S, Heiring J. Longitudinal study of death and institutionalization in patients with primary degenerative dementia. Journal of the American Geriatrics Society. 1988; 36 (2): 108-112. doi: 10.1111/j.1532-5415.1988.tb01778.x.
Knopman DS, Berg JD, Thomas R, Grundman M, Thal LJ, Sano M. Nursing home placement is related to dementia progression: experience from a clinical trial. Neurology. 1999; 52 (4): 714-718. doi: 10.1212/wnl.52.4.714
Miller SC, Prohaska TR, Furner SE, Freels S, Brody JA, Levy PS. Time to nursing home admission for persons with Alzheimer’s disease: the effect of health care system characteristics. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 1998; 53 (6): S341-S353. doi: 10.1093/geronb/53b.6.s341.
Severson MA, Smith GE, Tangalos EG, et al. Patterns and predictors of institutionalization in community-based dementia patients. Journal of the American Geriatrics Society. 1994; 42 (2): 181-185. doi: 10.1111/j.1532-5415.1994.tb04949.x.
Stern Y, Tang MX, Albert MS, et al. Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA. 1997; 277 (10): 806-812. doi: 10.1001/jama.1997.03540340040030.
Colerick EJ, George LK. Predictors of institutionalization among caregivers of patients with Alzheimer’s disease. Journal of the American Geriatrics Society. 1986; 34 (7): 493-498. doi: 10.1111/j.1532-5415.1986.tb04239.x.
Fisher L, Lieberman MA. A longitudinal study of predictors of nursing home placement for patients with dementia: the contribution of family characteristics. The Gerontologist. 1999; 39 (6): 677-686. doi: 10.1093/geront/39.6.677.
Gambassi G, Landi F, Lapane KL, Sgadari A, Mor V, Bernabei R. Predictors of mortality in patients with Alzheimer’s disease living in nursing homes. Journal of Neurology, Neurosurgery & Psychiatry. 1999; 67 (1): 59-65. doi: 10.1136/jnnp.67.1.59.
Hjaltadóttir I, Hallberg IR, Ekwall AK, Nyberg P. Predicting mortality of residents at admission to nursing home: A longitudinal cohort study. BMC Health Services Research. 2011; 11 (1): 86. doi: 10.1186/1472-6963-11-86.
Mitchell SL, Morris JN, Park PS, Fries BE. Terminal care for persons with advanced dementia in the nursing home and home care settings. Journal of Palliative Medicine. 2004; 7 (6): 808-816. doi: 10.1089/jpm.2004.7.808.
Callahan CM, Arling G, Tu W, et al. Transitions in care for older adults with and without dementia. Journal of the American Geriatrics Society. 2012; 60 (5): 813-820. doi: 10.1111/j.1532-5415.2012.03905.x.
Tang F, Lee Y. Home-and community-based services utilization and aging in place. Home Health Care Services Quarterly. 2010; 29 (3): 138-154. doi: 10.1080/01621424.2010.511518.
Zarit SH, Gaugler JE, Jarrott SE. Useful services for families: research findings and directions. International Journal of Geriatric Psychiatry. 1999; 14 (3): 165-178. doi: 10.1002/(sici) 1099-1166 (199903) 14: 3 < 165::aid-gps966 > 3.3.co; 2-f.
Zarit SH, Stephens MAP, Townsend A, Greene R. Stress reduction for family caregivers: effects of adult day care use. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 1998; 53B (5): S267-S278. doi: 10.1093/geronb/53b.5.s267.
Gaugler JE, Kane RL, Kane RA, Newcomer R. Early community-based service utilization and its effects on institutionalization in dementia caregiving. The Gerontologist. 2005; 45 (2): 177-185. doi: 10.1093/geront/45.2.177.
Luppa M, Luck T, Brahler E, Koenig HH, Riedel-Heller SG. Prediction of institutionalization in dementia. Dementia and Geriatric Cognitive Disorders. 2008; 26 (1): 65-78. doi: 10.1159/000144027.
Kelly R, Puurveen G, Gill R. The effect of adult day services on delay to institutional placement. Journal of Applied Gerontology. 2014; 35 (8): 814-835. doi: 10.1177/0733464814521319.
Gaugler JE, Zarit SH. The effectiveness of adult day services for disabled older people. Journal of Aging & Social Policy. 2001; 12 (2): 23-47. doi: 10.1300/j031v12n02_03.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group* under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease. Neurology. 1984; 34 (7): 939. doi: 10.1212/wnl.34.7.939.
Doody RS, Pavlik V, Massman P, Rountree S, Darby E, Chan W. Predicting progression of Alzheimer’s disease. Alzheimer’s Research & Therapy. 2010; 2 (2): 1-9. doi: 10.1186/alzrt25.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975; 12 (3): 189-198. doi: 10.1016/0022-3956 (75) 90026-6.
Doody RS, Dunn JK, Huang E, Azher S, Kataki M. A method for estimating duration of illness in Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders. 2004; 17 (1-2): 1-4. doi: 10.1159/000074078.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969; 9 (3): 179-186. doi: 10.1093/geront/9.3_part_1.179.
SAS software. Cary, NC: SAS Institute Inc.; 2014.
Wattmo C, Wallin ÅK. Early-versus late-onset Alzheimer disease: long-term functional outcomes, nursing home placement, and risk factors for rate of progression. Dementia and Geriatric Cognitive Disorders Extra. 2017; 7 (1): 172-187. doi: 10.1159/000455943.
Takahashi PY, Tung EE, Crane SJ, Chaudhry R, Cha S, Hanson GJ. Use of the elderly risk assessment (ERA) index to predict 2-year mortality and nursing home placement among community dwelling older adults. Archives of Gerontology and Geriatrics. 2012; 54 (1): 34-38. doi: 10.1016/j.archger.2011.02.012.
Rountree SD, Chan W, Pavlik VN, Darby EJ, Doody RS. Factors that influence survival in a probable Alzheimer disease cohort. Alzheimer’s Research & Therapy. 2012; 4 (3): 1-6. doi: 10.1186/alzrt119.
Powers M. The community’s emerging role in value-based health and social services. Generations. 2018; 42 (1): 4-8.
Subira B. The value of the hospital-CBO partnerships in achieving the triple aim. Generations. 2018; 42 (1): 9-13.
Karlin BE, Visnic S, McGee JS, Teri L. Results from the multisite implementation of STAR-VA: a multicomponent psychosocial intervention for managing challenging dementia-related behaviors of veterans. Psychological Services. 2014; 11 (2): 200-208. doi: 10.1037/a0033683.
Wattmo C, Wallin AK, Londos E, Minthon L. Risk factors for nursing home placement in Alzheimer's disease: a longitudinal study of cognition, ADL, service utilization, and cholinesterase inhibitor treatment. The Gerontologist. 2010; 51 (1): 17-27. doi: 10.1093/geront/gnq050.
Doody RS, Massman P, Dunn JK. A method for estimating progression rates in Alzheimer disease. Archives of Neurology. 2001; 58 (3): 449-454. doi: 10.1001/archneur.58.3.449.
Doody R, Pavlik V, Massman P, et al. Changing patient characteristics and survival experience in an Alzheimer's center patient cohort. Dementia and Geriatric Cognitive Disorders. 2005; 20 (2): 198-208. doi: 10.1159/000087300.
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