Predictors of institutionalization in people with dementia: a survey linked with administrative data

Background For people with dementia, moving into a nursing home is usually considered at some point in time. Currently available information on predictors of institutionalization is often based on small sample sizes, not taking competing risks into account, and with inconclusive results for sex. Aims We aimed to carry out an analysis stratified by sex and using a competing risk approach. Methods We carried out an analysis of a survey linked with administrative data including 652 people with dementia, aged 60 years and older. The follow-up was up to 4.5 years. We used the cumulative incidence function for examining time until institutionalization and survival time and the sub-distribution hazard model for estimating hazard ratios. Results The participants were on average 81 years old, about 51% were female. At the end of the follow-up, 282 people had been institutionalized and 273 had died. The regression models show that the risk of institutionalization is higher in women than in men and when cared for by a care service in comparison to an informal caregiver. Inhibiting factors are Care Level (II, III) and positive evaluation of caregiving by caregivers. Stratified analysis by sex revealed that the risk of institutionalization in men is influenced by their relationship to their caregiver, in women by duration of care at baseline. Discussion Sex seems to play a role in predicting institutionalization. Conclusion Future research should focus on stratified analysis by sex. Knowing the predictors of institutionalization for men and women could influence long-term care management remarkably.