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

2010 ◽  
Vol 23 (1) ◽  
pp. 44-53 ◽  
Author(s):  
Edward Alan Miller ◽  
Lon S. Schneider ◽  
Robert A. Rosenheck
Keyword(s):  
Mental Health ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Health Utility Index ◽  
Health Utility ◽  
Community Dwelling ◽  
Nursing Home Admission ◽  
Outpatient Mental Health ◽  
Nursing Home Entry

ABSTRACTBackground: 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.

scholarly journals Hallucinations in a Patient with Alzheimer’s Disease During the COVID-19 Crisis: A Case Study

2020 ◽  
Vol 4 (1) ◽  
pp. 455-458
Author(s):  
Mohamad El Haj ◽  
Frank Larøi ◽  
Karim Gallouj
Keyword(s):  
Mental Health ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Family Members ◽  
Physical Contact ◽  
Daily Activities ◽  
Social Distancing

While social distancing may be deemed necessary in order to avoid COVID-19 infections, the lockdown may impact mental health of patients with Alzheimer’s disease (AD). We present a case study involving hallucinations in a patient with AD who lives in a nursing home during the COVID-19 crisis. We compared this patient’s hallucination scores before and during the lockdown. We observed increased hallucinations during, compared to before, the lockdown. These increased hallucinations can be attributed to a number of elements such as the decreased in daily activities, social distancing, lack of physical contact with family members, and loneliness during the lockdown.

scholarly journals The association between aspects of carer distress and time until nursing home admission in persons with Alzheimer’s disease and dementia with Lewy bodies

2020 ◽  
pp. 1-9
Author(s):  
Toril Marie Terum ◽  
Ingelin Testad ◽  
Arvid Rongve ◽  
Dag Aarsland ◽  
Ellen Svendsboe ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Social Life ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Partial Least Square ◽  
Least Square ◽  
Nursing Home Admission ◽  
Relative Stress

Abstract Objective: The aim of this study was to explore the association between specific aspects of carer distress and time until nursing home admission (NHA) in people with mild dementia. Design: Prospective cohort study. Setting: Participants were recruited from the Dementia Study of Western Norway (DemVest). Participants: This study included 107 participants admitted to a nursing home who were diagnosed with Alzheimer’s disease (AD, n = 64) and dementia with Lewy bodies (DLB, n = 43) and their primary carers. Measurements: The Relative Stress Scale (RSS) was used to assess the level of reported distress in carers. Adjusted partial least square (PLS) prediction analysis of baseline items of the RSS was used to study the associations between individual items of the RSS and time until NHA. Results: Carer distress is an important contributor to early NHA, explaining 19.3% of the total variance of time until NHA in the model without covariates. In the adjusted PLS model, the most important RSS predictors of time until NHA were feeling frustrated (estimate = −137; CI, −209, −64.5), having limitations on social life (estimate = −118; CI, −172, −64), not being able to get away on vacation (estimate −116; CI, −158.3, −73.7), and feeling unable to cope with the situation (estimate = −63; CI, −122.6, −3.4). Conclusions: Preservation of the informal care capacity represents important steps for improving the management of resources in dementia care. This study identifies aspects of carer distress associated with a shorter time until NHA. Looking beyond the sum score of the RSS helps promote the development of flexible and tailored interventions and perhaps delay NHA.

scholarly journals The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer’s disease: A matched case–control study

2016 ◽  
Vol 4 ◽  
pp. 205031211666187 ◽  
Author(s):  
Candace N Porter ◽  
Margaret C Miller ◽  
Marcia Lane ◽  
Carol Cornman ◽  
Khaled Sarsour ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Psychological Symptoms ◽  
Nursing Home Placement ◽  
Nursing Home Admission ◽  
Neuropsychiatric Inventory ◽  
Matched Case ◽  
Home Placement ◽  
Behavioral And Psychological Symptoms

Objectives: Behavioral and psychological symptoms of dementia in individuals with Alzheimer’s disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case–control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement. Methods: Data from the South Carolina Alzheimer’s disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied. Results: A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14–1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission. Conclusion: Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer’s disease and caregiver support services are necessary to prevent or delay nursing home admission.

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