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Predictors of nursing home admission among Alzheimer's disease patients with psychosis and/or agitation

Published online by Cambridge University Press:  10 March 2010

Edward Alan Miller ,
Lon S. Schneider  and
Robert A. Rosenheck
Edward Alan Miller*
Affiliation:
Department of Gerontology and Gerontology Institute, McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, MA, U.S.A.
Lon S. Schneider
Affiliation:
University of Southern California Keck School of Medicine, Los Angeles, CA, U.S.A.
Robert A. Rosenheck
Affiliation:
Yale University School of Medicine and VA New England Mental Illness Research and Education Center, West Haven, CT, U.S.A.
*
Correspondence should be addressed to: Edward Alan Miller, Department of Gerontology, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, U.S.A. Phone: +1 617-287-7313, Fax: +1 617-287-7080. Email: [email protected].
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Abstract

Background: The purpose of this study is to identify factors that predict nursing home placement among community-dwelling Alzheimer's disease (AD) patients with psychosis and/or agitation in a randomized clinical trial (ClinicalTrials.gov number, NCT00015548).

Methods: 418 participants with AD enrolled in the Clinical Antipsychotic Trial of Intervention Effectiveness – AD (CATIE-AD) trial of anti-psychotic medications and having no evidence of nursing home use at baseline were followed at 9 months post-random assignment using data provided by caregiver proxy. χ2 tests, t-tests and Cox proportional hazard modeling were used to examine the baseline correlates of nursing home use.

Results: Of outpatients with no prior nursing home use, 15% were placed in a nursing home in the 9 months following baseline, with the average time to placement being 122 days. Bivariate analyses indicate that those with prior outpatient mental health use at study entry were more likely to be admitted; so too were those with worse physical functioning – i.e. lower scores on the AD Cooperative Study Activities of Daily Living Scale (ADCS-ADL), lower utility scores on the Health Utility Index (HUI)-III, and worse cognition on the Mini-mental State Examination. Controlling for other factors, non-Hispanic white race (hazard ratio [HR] = 2.16) and prior mental health use (HR = 1.87) increased the likelihood of admission. Those with higher ADCS-ADL scores were less likely to be placed (HR = 0.97).

Conclusions: Factors leading to nursing home entry among psychotic/agitated AD patients are similar to the general population, though high incidence of nursing home entry highlights the importance of accounting for such utilization in health economic studies of AD outcomes. It also highlights the importance of using information on ADLs and other characteristics to develop profiles identifying those at greater or lesser risk of nursing home entry and, in so doing, inform population planning associated with AD and identification of those patients and caregivers who might benefit most from interventions to prevent eventual placement.

Keywords

institutionalizationelderlyclinical trialdementiarisk factorssurvival analysismental healthpsychiatry
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 1 , February 2011 , pp. 44 - 53
Copyright
Copyright © International Psychogeriatric Association 2010

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References

AD2000 Collaborative Group (2004). Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. The Lancet, 363, 2105–2115.CrossRefGoogle Scholar
Alzheimer's Association (2009). Alzheimer's Disease Facts and Figures. Chicago: Alzheimer's Association.Google Scholar
Anderson, R. (1995). Revisiting the behavior model and access to care: does it matter? Journal of Health and Social Behavior, 36, 1–10.CrossRefGoogle Scholar
Beller, S. A. and Overall, J. E. (1984). The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research: II. Representative profile patterns. Journal of Gerontology, 39, 194–200.CrossRefGoogle ScholarPubMed
Blaum, C. S., Ofstedal, M. B. and Liang, J. (2002). Low cognitive performance, comorbid disease, and task-specific disability: findings from a nationally representative survey. Journal of Gerontology: Medical Sciences, 57A, M523–M531.Google Scholar
Castle, N. G. (2002). Deficiency citations for mental health care in nursing homes. Administration and Policy in Mental Health, 29, 157–171.CrossRefGoogle Scholar
Chan, D. C., Kasper, J. D., Black, B. S. and Rabins, P. V. (2003). Presence of behavioral and psychological symptoms predicts nursing home placement in community-dwelling elders with cognitive impairment in univariate but not multivariate analysis. Journal of Gerontology: Medical Sciences, 58A, 548–554.Google Scholar
Colenda, C. C., Streim, J., Greene, J. A., Meyers, N., Beckwith, E. and Rabins, P. 1999. The impact of OBRA ’87 on psychiatric services in nursing homes: joint testimony of the American Psychiatric Association and American Association for Geriatric Psychiatry. American Journal of Geriatric Psychiatry, 7, 12–17.Google ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Davis, K. L., Marin, D. B., Kane, R., Patrick, D., Raskind, M. A. and Puder, K. L. (1997). The Caregiver Activity Survey (CAS): development and validation of a new measure for caregivers of persons with Alzheimer's disease. International Journal Geriatric Psychiatry, 12, 978–988.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Feeny, D. et al. (2002). Multi-attribute and single attribute utility functions for the Health Utilities Index Mark 3 system. Medical Care, 40, 113–128.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Galasko, D. et al. (1997). An inventory to assess Activities of Daily Living for clinical trials in Alzheimer's disease. Alzheimer Disease and Associated Disorders, 22, S33–S39.CrossRefGoogle Scholar
Gaugler, J. E., Duyal, S. and Anderson, K. A. (2007). Predicting nursing home admission in the U.S.: a meta-analysis. BMC Geriatrics, 19, 7.13.Google Scholar
Gaugler, G. E., Yu, F., Krichbaum, K. and Wyman, J. F. (2009). Predictors of nursing home admission for persons with dementia. Medical Care, 47, 191–198.CrossRefGoogle ScholarPubMed
Gilley, D. W., Bienias, J. L., Wilson, R. S., Benett, D. A., Beck, T. L. and Evans, D. A. (2004). Influence of behavioral symptoms on rates of institutionalization for persons with Alzheimer's disease. Psychological Medicine, 34, 1129–1135.CrossRefGoogle ScholarPubMed
Green, C. (2007). Modeling disease progression in Alzheimer's disease: a review of modeling methods used for cost-effectiveness analyses. Pharmacoeconomics, 25, 735–750.CrossRefGoogle Scholar
Hatoum, H. T., Thomas, S. K., Lin, S. J., Lane, R. and Bullock, R. (2009). Predicting time to nursing home placement based on activities of daily living scores – a modeling analysis using data on Alzheimer's diseae patients receiving rigastigmine or donepezil. Journal of Medical Economics, 12, 98–103.CrossRefGoogle ScholarPubMed
Hebert, R., Dubois, M. F., Wolfson, C., Chambers, L., and Cohen, C. (2001). Factors associated with long-term institutionalization of older people with dementia: data from the Canadian study of health and aging. Journal of Gerontology: Medical Sciences, 56A, M693–M699.Google Scholar
Hebert, L. E., Scherr, P. A., Bienias, J. L., Bennett, D. A. and Evans, D. A. (2003). Alzheimer disease in the US population: prevalence estimates from the 2000 census. Archives of Neurology, 60, 1119–1122.CrossRefGoogle ScholarPubMed
Knopman, D. et al. (1996). Long-term tacrine (Cognex) treatment: effects on nursing home placement and mortality. Neurology, 47, 166–177.CrossRefGoogle ScholarPubMed
Knopman, D. S., Berg, J. D., Thomas, R., Grundman, M., Thal, L. J. and Sano, M. (1999). Nursing home placement is related to dementia progression. Neurology, 52, 714–718.Google Scholar
Loewenstein, D. A. et al. (2001). Caregivers’ judgments of the functional abilities of the Alzheimer's disease patient: a comparison of proxy reports and objective measures. Journal of Gerontology, Series B, 2, P78–P84.Google Scholar
Magaziner, J. et al. (2000). The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: diagnosis by expert panel. The Gerontologist, 40, 663–672.CrossRefGoogle Scholar
Miller, E. A. and Rosenheck, R. A. (2006). Risk of nursing home admission in association with mental illness nationally in the Department of Veterans Affairs. Medical Care, 44, 343–351.CrossRefGoogle ScholarPubMed
Miller, E. A. and Weissert, W. G. (2000). Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Medical Care Research and Review, 57, 259–297.CrossRefGoogle ScholarPubMed
Miller, E. A. and Weissert, W. G. (2001). Incidence of four adverse outcomes in the elderly population: implications for home care policy and research. Home Health Care Services Quarterly, 20:17–47.CrossRefGoogle ScholarPubMed
Miller, E. A., Allen, S. M. and Mor, V. (2009). Navigating the labyrinth of long-term care: shoring up informal caregiving in a home- and community-based world. Journal of Aging and Social Policy, 21, 1–16.CrossRefGoogle Scholar
Office of the Inspector General (2001). Younger Nursing Facility Residents with Mental Illness: Preadmission Screening and Resident Review (PASRR) Implementation and Oversight. Rockville, MD: U.S. Department of Health and Human Services.Google Scholar
Orry, M. G., Hoffman, R. R., Yee, J. L., Tennstedt, S. and Schulz, R.Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. The Gerontologist, 39, 177–185.CrossRefGoogle Scholar
Rabins, P. V., Kasper, J. D., Kleinman, L. and Black, B. S. (1999). Concepts and methods in the development of the ADRQL: an instrument for assessing health-related quality of life in persons with Alzheimer's disease. Journal of Mental Health and Aging, 5, 33–48.Google Scholar
Reichman, W. E. et al. (1998). Psychiatric consultation in the nursing home: a survey of six states. American Journal of Geriatric Psychiatry, 6, 320–327.Google ScholarPubMed
Shea, D. G., Russo, P. A. and Smyer, M. A. (2000). Use of mental health services by persons with a mental illness in nursing facilities: initial impacts of OBRA 87. Journal of Aging and Health, 12, 560–578.CrossRefGoogle Scholar
Rosenheck, R. A. et al. (2007). Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer Disease. Archives of General Psychiatry, 64, 1259–1268.CrossRefGoogle Scholar
Schneider, L. S. and Dagerman, K. S. (2004). Psychosis of Alzheimer's disease: clinical characteristics and history. Journal of Psychiatric Research, 38, 105–111.CrossRefGoogle ScholarPubMed
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.Google Scholar
Smith, G. E., Kokmen, E. and O'Brien, P. C. (2000). Risk factors for nursing home placement in a population-based dementia cohort. Journal of the American Geriatrics Society, 48, 519–525.CrossRefGoogle Scholar
Smith, G. E., O'Brien, P. C., Ivnik, R. J., Kokemen, E. and Tangalos, E. G. (2001). Prospective analysis of risk factors for nursing home placement of dementia patients. Neurology, 57, 1467–1473.CrossRefGoogle ScholarPubMed
Spruytte, N., van Audenhove, C. and Lammertyn, F. (2001). Predictors of institutionalization of cognitively-impaired elderly cared for by their relatives. International Journal Geriatric Psychiatry, 16, 1119–1128.CrossRefGoogle ScholarPubMed
Stern, Y. et al. (1997). Predicting time to nursing home care and death in individuals with Alzheimer Disease. JAMA, 277, 806–812.CrossRefGoogle ScholarPubMed
Taylor, D. H. and Sloan, F. (2000). How much do persons with Alzheimer's disease cost Medicare? Journal of the American Geriatrics Society, 48, 639–646.CrossRefGoogle ScholarPubMed
Weissert, W. G. and Miller, E. A. (2001). Balancing resources and risk: selecting home care clients in Florida's CARES program. Home Health Care Services Quarterly, 18, 63–76.CrossRefGoogle Scholar
Weissert, W. G., Hirth, R. A., Chernew, M. E., Diwan, S. and Kim, J. (2003). Case management: effects of improved risk and value information. The Gerontologist, 43, 797–805.CrossRefGoogle ScholarPubMed
Yaffe, K. et al. (2002). Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA, 287, 2090–2097.CrossRefGoogle ScholarPubMed