Precipitating and Predisposing Events and Symptoms For Admission to Assisted Living or Nursing Home Care

Abstract

BackgroundIn Canada, the rise of private-pay assisted living facilities is changing the long-term care landscape. Even so, few clinical implications of having these facilities in the spectrum of care have been studied. Our objective was to compare events and symptoms that might predispose and precipitate a move of older adults to assisted living or to a nursing home.MethodsCross-sectional, descriptive Nova Scotia survey of residents and family members on admission. Health-care use and dementia diagnosis were recorded from the admission record. Dementia was staged using the Global Deterioration Scale and the Dependence Scale. The SymptomGuide, a standardized dementia symptom inventory, was used to assay which symptoms were most influential in the decision to seek long term care. Caregiver stress was elicited by a self-report questionnaire.ResultsOf 353 people admitted during the enrolment period, 174 (49%) took part in the survey. Most (97; 55.7%) were involved in a move from the community to a nursing home, 54 (31.0%) from the community to assisted living, and 23 (13.2%) from assisted living to a nursing home. In each setting, dementia was the commonest predisposing factor (seen in >90%) with a precipitating event seen in 120 (69%) people. The precipitating events included a medical illness (n = 97; 55%) or caregiver illness, death or move (33; 19%). Dependence was associated with place of care, with more severely impaired people more commonly represented in people who moved to nursing homes.ConclusionsPeople move from the community chiefly due to dementia, and often with a precipitant. Compared with a move to assisted living, moving to nursing homes generally indicates greater dependence, and typically worse dementia severity. Even so, assisted-living facilities are not just for the “worried well”, but are used by people with dementia, caregiver stress, and recent hospitalization.

Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

“…Many previous studies have cited factors such as CI (Andel, et al, 2007; Greiner, et al, 2014), caregiver burden (Rockwood et al, 2014) and impairments in ADLs/IADLs (Verbeek, et al, 2015) as risk factors for LTC admission, in line with the current findings. Even after adjusting for other important potential confounders, a diagnosis of dementia nearly doubled a person’s risk.…”

Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada

“…Similar to trends observed in the US, 5e11 older adults with dementia, often with significant comorbidity, are increasingly being cared for in assisted living (AL) settings within Canada. 12,13 Current estimates suggest that between 40% and 60% of AL residents across North America have a diagnosis of dementia. 5,9,12 The rapid expansion of AL over recent years reflects both the lower costs of this residential option compared with long-term (ie, nursing home) care (LTC) as well as individual preferences for more homelike settings.…”

Marital Status and Persons With Dementia in Assisted Living

“…As we previously noted, residents with dementia in AL who consistently disturb other residents or activities are more likely to be transferred to a nursing home. 7 The study findings underscore the role of family members, in particular, spouses, to provide additional supports for loved ones with dementia in AL as a way of augmenting AL services.…”

“…The symptoms of dementia are often an influential factor for residents relocating from an AL to a nursing home setting. 7 Research further suggests that residents with behavioral symptoms associated with cognitive deficits are more likely to be discharged from AL, although this varies among AL settings. 6 Previous research suggests that a significant number of residents in dementia-specific AL settings transferred to skilled nursing facilities over 9 months.…”