Predictors of Institutionalization in Demented Patients Discharged From a Rehabilitation Unit

Rozzini, Luca; Cornali, Claudio; Chilovi, Barbara Vicini; Ghianda, Diego; Padovani, Alessandro; Trabucchi, Marco

doi:10.1016/j.jamda.2005.11.008

Cited by 46 publications

(41 citation statements)

References 29 publications

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“…Whereas many previous studies show caregiver burden to be a strong predictor for institutionalization, 13,14,29,30 only 15% of caregivers actually declare their burden as a reason for institutionalization. This is an interesting result because it may imply that caregivers do not (always) label what is considered 'burden' by formal caregivers as such.…”

Section: Discussionmentioning

confidence: 64%

Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries

Afram¹,

Stephan

Verbeek³

et al. 2014

Journal of the American Medical Directors Association

183

146

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Objectives:To explore reasons for institutionalization of people with dementia according to informal caregivers as well as variation in reasons between countries.Design: An explorative cross-sectional study was conducted in eight European countries. Setting:Per country a minimum of three long-term care facilities, offering care and accommodation as a package, participated in this study. Participating countries were selected to represent different geographic areas in Europe. Participants:Of the 791 informal caregivers involved in the RightTimePlaceCare project of people with dementia who were recently admitted to a long-term care facility, 786 were included for this study. Measurements:As part of a semi-structured interview, informal caregivers were asked the main reason for institutionalization in an open-ended question. Answers were categorized according to a conventional coding approach. All reasons were then quantified and tested. Results:Mainly patient related reasons were stated, such as neuropsychiatric symptoms (25%), care dependency (24%) and cognition (19%). Neuropsychiatric symptoms were among the most often mentioned reasons in the majority of countries. Beside patient related reasons, caregiver burden and the inability of the informal caregiver to care for the patient were stated as reasons (both 15%). Further analyses showed countries differ significantly in reasons according to informal caregivers. Additionally, reasons were analysed for spouses and child-caregivers, showing that spouses more often stated reasons related to themselves compared to child-caregivers. Conclusion:Multiple reasons contribute to the institutionalization for people with dementia, with several factors that may influence why there were country differences. Variation in the organization of dementia care and cultural aspects, or the relationship between the informal caregiver and person with dementia may be factors influencing the reasons. Because of a wide variation in reasons between countries, no one-size-fits-all approach can be offered to guide informal caregivers when facing the possibility of institutionalization of the person with dementia.

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Section: Discussionmentioning

confidence: 64%

Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries

Afram¹,

Stephan

Verbeek³

et al. 2014

Journal of the American Medical Directors Association

183

146

View full text Add to dashboard Cite

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“…Compared to the two Dutch studies it seems that patients with dementia living at home differ in their symptom expression from the nursing home patients with dementia. This difference could be due to dementia severity, but also to environmental factors, caregiver burden and pharmacological and non-pharmacological interventions (Rozzini et al, 2006). We noted that the use of psychotropic drugs was very common among our study subjects; 83.4% of them used at least one psychotropic drug at one assessment during the 16 months period.…”

Section: Persistence Resolution and Possible Influence Of Psychotropmentioning

confidence: 69%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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ObjectiveThe Severe Impairment Battery (SIB) is developed to test cognitive function in patients with dementia of moderate to severe degree. We have conducted a study to assess the inter‐rater reliability and the validity of the Norwegian version of SIB.MethodsThe reliability study comprised 30 patients, and the validity study 59 patients in nursing homes. We assessed Cronbach's alpha coefficient of the scale and the inter‐rater reliability for the total SIB score and its nine sub scores between two testers by means of the Spearman's correlation coefficients. In the validity study we compared the SIB scores with the scores on the Clinical Dementia Rating Scale.ResultsThe mean SIB score was 72.10 (SD 25.37). The Cronbach's alpha was 0.97, and the inter‐rater reliability of total SIB score was Spearman's rho 0.85, and ranged from 0.46 to 0.76 for the nine sub‐scores. The mean SIB score for patients with a CDR score < 2 was 84.2(13.4), whereas total scores for patients with CDR 2 and 3 were 74 (18.9) and 48.4 (33.3), respectively. A cut‐off point of 80.5 points gave the highest accuracy in discriminating between patients with CDR 2 and CDR 3, while a cut‐off point of 87.5 best discriminated between CDR < 2 and CDR 3.ConclusionThe study indicates that the Norwegian version of SIB is a reliable and valid test with which to evaluate the cognition in patients with dementia of moderate to severe degree. Copyright © 2008 John Wiley & Sons, Ltd.

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“…Increasing age, living alone, cognitive impairment particularly dementia, psychiatric diagnoses, and limited functional performance (activities of daily living and instrumental activities of daily living) have all been shown to strongly predict the need for skilled care in the United States and Europe. [11][12][13][14][15]36,37 These findings uniquely inform clinical decision making as they are derived from the largest non-proprietary longitudinal data set concerning individuals with TBI that is representative of patients receiving inpatient rehabilitation for TBI in the United States. 22,23 While age and pre-injury living status are important to consider when establishing a plan of care on admission to IR, skills for independence improve with recovery, making prediction of outcome for any individual challenging and the discharge planning process dynamic.…”

Section: Discussionmentioning

confidence: 99%

“…In U.S. and European older adults (non-TBI population), consistent and stable risk factors for NF placement include greater age, living alone, functional motor dependence in basic care activities, and cognitive impairment, including dementia and delirium. [11][12][13][14][15][16] Within the TBI population, greater severity of injury has been associated with institutionalization. 17,18 However, no studies have addressed the contribution of the modifiable functional predictors on institutionalization after rehabilitation of people with TBI.…”

Section: Introductionmentioning

confidence: 99%

Predicting Institutionalization after Traumatic Brain Injury Inpatient Rehabilitation

Eum

Seel

Goldstein

et al. 2015

Journal of Neurotrauma

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Risk factors contributing to institutionalization after inpatient rehabilitation for people with traumatic brain injury (TBI) have not been well studied and need to be better understood to guide clinicians during rehabilitation. We aimed to develop a prognostic model that could be used at admission to inpatient rehabilitation facilities to predict discharge disposition. The model could be used to provide the interdisciplinary team with information regarding aspects of patients' functioning and/or their living situation that need particular attention during inpatient rehabilitation if institutionalization is to be avoided. The study population included 7219 patients with moderate-severe TBI in the Traumatic Brain Injury Model Systems (TBIMS) National Database enrolled from 2002-2012 who had not been institutionalized prior to injury. Based on institutionalization predictors in other populations, we hypothesized that among people who had lived at a private residence prior to injury, greater dependence in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence, feeding, and comprehension at admission to inpatient rehabilitation programs would predict institutionalization at discharge. Logistic regression was used, with adjustment for demographic factors, proxy measures for TBI severity, and acute-care length-of-stay. Cstatistic and predictiveness curves validated a five-variable model. Higher levels of independence in bladder management (adjusted odds ratio [OR], 0.88; 95% CI 0.83, 0.93), bed-chair-wheelchair transfers (OR, 0.81 [95% CI,, and comprehension (OR, 0.78 [95% CI, 0.68, 0.89]) at admission were associated with lower risks of institutionalization on discharge. For every 10-year increment in age was associated with a 1.38 times higher risk for institutionalization (95% CI, 1.29, 1.48) and living alone was associated with a 2.34 times higher risk (95% CI, 1.86, 2.94). The c-statistic was 0.780. We conclude that this simple model can predict risk of institutionalization after inpatient rehabilitation for patients with TBI.

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Predictors of Institutionalization in Demented Patients Discharged From a Rehabilitation Unit

Cited by 46 publications

References 29 publications

Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries

Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Predicting Institutionalization after Traumatic Brain Injury Inpatient Rehabilitation

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