The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: A prospective observational cohort study

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Abstract

Background

Dementia is a progressive neurological disorder that causes a high degree of dependency. This dependency has been defined as an increased need for assistance due to deterioration in cognition and physical functioning, and changes in behavior. Highly dependent people with dementia are more likely to be institutionalized.

Objectives

To investigate the association between specific categories of physical dependency and the presence of neuropsychiatric symptoms in people with dementia admitted to a long-term care institution.

Design

A prospective observational cohort study.

Settings

Home care and long-term care institutions in eight European countries.

Participants

People with dementia living at home but at risk of institutionalization and recently institutionalized people with dementia.

Method

Baseline and 3-month follow-up interviews were performed between November, 2010 and April, 2012. The sample consisted of 116 recently institutionalized dementia sufferers and 949 people with dementia still living at home. Physical dependency was measured using the Katz Activity of Daily Living index, and neuropsychiatric symptoms were assessed through The Neuropsychiatric Inventory. Specific categories of dependency were analyzed by performing a logistic regression analysis. This followed examination of baseline characteristics to define the degree of physical dependency, as factors associated with institutionalization, and evaluation of the same characteristics at 3-month follow-up to detect changes in the degree of physical dependency and neuropsychiatric symptoms associated with recent admission to a long-term care institution.

Results

Toileting, dressing and continence dependency was higher in institutionalized people than in those receiving home-care. Delusion, hallucination, agitation, anxiety, apathy, motor-disturbances, night-time behavior and eating disorders were also worse in the institutionalized. Logistic regression analysis showed that independent factors significantly associated with being recently institutionalized were toileting (odds ratio = 2.3; 95% confidence interval = 1.43–3.71) and motor disturbances (odds ratio = 1.81; 95% confidence interval = 1.15–2.87).

Conclusions

This study supports the association between type and degree of physical dependency in people with dementia and long-term institutionalization. Institutionalization is associated with physical dependency and the presence of neuropsychiatric symptoms.

Section snippets

Background

Dementia is a progressive neurological disorder that affects memory, thinking, language, judgment and behavior. It involves a high degree of physical dependency and represents a major challenge for society and health services (Gallese and Stobbione, 2013). Caring for older people with dementia is a complicated matter for family members, some of whom experience high levels of subjective burden and stress, social isolation and changes in patterns of family roles (Zhang et al., 2013). Thence,

Aim

The aim of the study was to investigate the association between physical dependency and the presence of neuropsychiatric symptoms in the admission of people with dementia to a long-term care institution (LTCI).

Study design

This prospective observational cohort study is part of the RightTimePlaceCare project (grant agreement 242153), which was conducted in 8 European countries: England, Estonia, Finland, France, Germany, the Netherlands, Spain and Sweden (Verbeek et al., 2012).

Population and sample

The population of interest was recently institutionalized people with dementia and people with dementia living at home but at risk of institutionalization (i.e., on the margins of admission to LTCI). A health care professional (e.g.,

Results

A total of 1065 dyads was included in the study and consisted of those who had completed baseline and follow-up measurements. From the overall sample, 116 people with dementia were institutionalized during the 3-month follow-up period (LTCI) while 949 participants remained at home (HC) despite still being at risk of institutionalization. From the sociodemographic characteristics recorded, age, income and living alone were variables with statistically significant differences when comparing

Discussion

This study investigated the association between specific categories of physical dependency, and behavioral disturbances, with the admission of people with dementia to a LTCI. The study was conducted from a European perspective, so differences between countries cannot be seen in the general analysis. Multiple reasons, mainly associated with people with dementia, contribute to their institutionalization, such as neuropsychiatric symptoms (behavioral disturbances) and care dependency (Afram et

Conclusion

This study builds on current international evidence supporting the association between specific categories of physical dependency and the presence of neuropsychiatric symptoms with the admission of people with dementia to a long-term care institution. The study results demonstrate the importance of considering the dependency of the people suffering from dementia in specific activities of daily living to identify the factors behind the final decision to their admission into a LTCI, as well as

Conflict of interest

No conflict of interest is declared.

Funding

This research was funded by a grant from the European Commission within the 7th Framework Program (Project 242153).

Ethical approval

Each country obtained ethical approval from a country-specific legal authority for research on human beings (for instance, an ethical committee specialized in medical or nursing science) to conduct the study in accordance with the national standards and regulations in participating countries. The specific names of each committee are as follows (with reference numbers if appropriate in brackets): Ethics Review Committee on Human Research of the University of Tartu (196/T-3), Ethical Committee of

Acknowledgments

The authors thank Belchin Adriyanov for all his help with the statistical analysis, and Carme Alvira, Marta Farré and Susana Miguel for all their help during the study development. The authors also thank Stephen Kelly for all his help with language revision and implication.

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  • Cited by (0)

    This paper was submitted as an entry for the European Academy of Nursing Science's Rosemary Crow award, sponsored by the International Journal of Nursing Studies. The award is open to current doctoral students or recent graduates of the academy's programme.

    1

    The RightTimePlaceCare Consortium is disclosed in Appendix 1.

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