Dementia often leads to nursing home admission

ANN ARBOR—Although Americans have more options in caring for elderly loved ones today than in the past and the medical community has new ways of treating Alzheimer’s disease, nursing home admissions remain steady.

Those with dementia are at least twice as likely as those without it to be admitted to a nursing home, according to an article in the recently published April/May/June issue of Alzheimer Disease and Associated Disorders.

Jane Banaszak-Holl, associate professor of health management and policy at the University of Michigan School of Public Health, is the lead author of a study analyzing data from nearly 7,000 respondents who participated in the U-M Institute for Social Research’s Health and Retirement Study between 1993 and 2000.

She said marked changes in nursing home alternatives such as skilled home care and in improved treatments for Alzheimer’s disease have made any previous studies seem outdated. So she embarked on her study.

"To some surprise, our study results indicate that those with cognitive impairments remained at high risk of nursing home admission, despite the increasing availability of substitute services and advances in clinical treatment options," the journal article states.

Banaszak-Holl said nobody wants to go into a nursing home—it is clearly the choice made when someone cannot remain at home because of mental or physical health limitations—so this study aims to understand what drives that decision.

Coauthor Ken Langa, an assistant professor of internal medicine and faculty associate at the U-M Institute for Social Research, said understanding these trends has huge implications ranging from government and private insurance funding for nursing home care to policy regulating long-term care options.

Other coauthors on the study are: A. Mark Fendrick, Norman Foster, A. Regula Herzog and Mohammed Kabeto at U-M; David Kent at Tufts University; and Walter Straus at Merck and Co.

The researchers found:

• 17 percent of the study participants were admitted to a nursing home, and that percentage did not decrease over the seven years of data.

• Those who were white, of increased age, with an absence of potential caregivers, those of lower net worth and suffering from dementia or chronic conditions such as heart disease or diabetes were all more likely to be admitted to a nursing home. Dementia has a stronger effect on nursing home admission than most other chronic medical conditions, however.

• Even modest improvements in physical function can significantly cut the likelihood of entering a nursing home.

• Nursing home admissions significantly increased for people with any degree of dementia, even when adjustments for functional status were made.

Banaszak-Holl said dementia is strongly connected to nursing home admission because of more than just the physical conditions, like difficulty showering or eating.

"There is something special about dementia care," she said. Family members are less likely to be able to cope with caring for someone with dementia, because it can trigger such things as wandering away from home, lashing out with aggression toward loved ones and confusion.

Langa said their research shows that a person with dementia is likely to be admitted to a nursing home within two or three years. That knowledge is also important for family members, who might need to begin making plans and who might cope with guilt associated with the nursing home decision by knowing they aren’t alone in making that choice.

Langa added that nursing home care is expensive as compared to alternatives such as in-home care, and this research begins to push the questions about how Americans will pay for the kind of care our aging population might need.

Going forward, the researchers plan to examine caregiver support issues—how to help families deal with the decision of whether a nursing home is the right choice. They are conducting field work interviewing about 850 people in the Health and Retirement Study about their health status and about caregiver decisions.

Related links:

Banaszak-Holl’s faculty profile

Langa’s faculty profile

ISR’s Health and Retirement Study

Alzheimer Disease and Associated Disorders

E-mail:cnewvine@umich.edu