Premium
P2‐317: Factors influencing time to nursing home placement in persons with probable Alzheimer's disease
Author(s) -
Nguyen Angeline,
McGee Jocelyn,
Chan Wenyaw,
Darby Eveleen,
Pavlik Valory,
Doody Rachelle
Publication year - 2012
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2012.05.1026
Subject(s) - medicine , proportional hazards model , respite care , dementia , psychological intervention , log rank test , disease , gerontology , demography , physical therapy , psychiatry , sociology
Background: Between 30-50% of people with dementia in high income countries live in resource/cost-intensive residential or nursing home care facilities despite the fact that most report a preference to remain in their own homes. There is a need to better identify those at risk for placement and to identify effective interventions for mitigating/reducing time to placement. The aims of this study were: 1) to examine the influence of pre-progression rate (PPR) on time to nursing home placement (NHP); and 2) to determine if disease severity at which home care/respite services (HCRS) are introduced makes a difference in delaying time to NHP.Methods: Individuals who met NINCDS-ADRDA criteria for probable AD were included (n1⁄4 1210). Preprogression rate was calculated at baseline (30-baseline MMSE)/estimated duration of symptoms in years). PPR allows for categorization of individuals during their first appointment as slow (0-1.9 MMSE points/year), intermediate (2-4.9 MMSE points/year), or rapid progressors (5 or more MMSE points/year). Severity of AD at first HCRS use was defined based on MMSE score (mild [20-30], moderate [11-19], or severe [1-10]). Analyses included univariate Cox proportional hazards regression and log rank test; Kaplan-Meier survival curves; and multivariate Cox proportional hazards regression. Results: In this sample, slower PPR was associated with longer delays to NHP even after adjusting for covariates (P<0.01). Disease severity at which HCRS was introduced made a difference in delaying time to NHP in the unadjusted model (P 1⁄4 0.03) but not in the adjusted model (P 1⁄4 0.39). Conclusions: PPR can be used by clinicians to identify people with AD who are at higher risk for NHP (e.g. rapid progressors) after initial assessment. Once identified, strategies aimed at mitigating or reducing time to NHP, such as HCRS, can be employed and more informed long-term planning can occur.