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PubMed1990

Concepts of emotion in institutionalized children.

Institutionalized children of 7, 11 and 15 years of age were interviewed with regard to their concept of emotion. Questions were posed pertaining to the identification of emotion, the effects of emotion on other psychological processes, and the strategies by which both the display and experience of emotion may be regulated. The results of this study were analysed together with those from an earlier study conducted by Harris, Olthof and Meerum Terwogt (1981) in which non-institutionalized schoolchildren were interviewed. The institutionalized children show the same general (development) shift in their conception of emotions, albeit in a delayed fashion in some cases, as was found in the earlier study for the non-institutionalized schoolchildren. That is to say, whereas the youngest children focus on the publicly observable components of an emotion, the older children also take the hidden mental aspect of an emotion into consideration. The institutionalized children differ from the non-institutionalized children in that they claim to be less attentive to their own emotions as well as those of others; they do not consider it feasible to actually change an emotion; and they consider the effect of emotions to be more detrimental. These results are discussed in terms of a learned helplessness explanation.

Adolescent↗

PubMed2004

[Variables associated with functional recovery and post-discharge institutionalization of elderly cared in an average stay geriatric unit].

BASIS: To describe the evolution and results of the rehabilitation of elderly disabled cared in an average stay geriatric unit, and to define the factors associated with functional improvement and post-discharge institutionalization. PATIENTS AND METHOD: Observational longitudinal study in 459 patients with functional disability consecutively hospitalized between May 2000 and December 2001. Basal variables collected included the clinical, functional, mental, and sociodemographic manifestations previous to the admission. The favorable functional response (defined as a functional gain during the admission of > or = 20 points in the Barthel index) and the post-discharge institutionalization were regarded the main result variables. RESULTS: The average age of patients was 80.56 (SD: +/- 7.45) years, 64.9% were women and 81% came from acute hospital units; the main cause of disability was stroke (48.5%) followed by orthopedic pathology (26.2%) and immobility for different causes (23.5%). 72.5% of patients get functional improvement and 16.4% were institutionalized after the discharge. The main independent risk factors for poor functional response found in the multivariate analysis were a scoring in Pfeiffer's cognitive test of 5-7 points (OR: 0.42; 95% CI: 0,22-0.78) and > or = 8 (OR: 0.29; 95% CI: 0.12-0.71), and a scoring in Barthel's index < 60 prior to the deterioration (OR: 0.36; 95% CI: 0.14-0.93). Independent risk factors for institutionalization after the discharge were age (OR: 1.06; 95% CI: 1.01-1.12), and a scoring in the Gijon's sociofamiliar scale > or = 9 (OR: 6.83; 95% CI: 1.91-24.47). A functional disability after the discharge in the Barthel's index < 40 also was independently associated to post-discharge institutionalization (OR: 3,07; 95% CI: 1.04-10.06). CONCLUSIONS: Most of elderly with recent disability benefit functionally from care in specific hospital geriatric units. Moderate or severe cognitive deterioration after hospitalization is associated to lower recovery probability. Very advanced age, higher social precariousness and severe disability after discharge are associated with higher risk of institutionalization.

Aftercare↗

PubMedDate not supplied

Incontinence and troublesome behaviors predict institutionalization in dementia.

Factors predicting the early institutionalization of demented patients were studied in 143 outpatients using univariate and multivariate life-table methods. Four types of factors were evaluated for prognostic value: severity of functional impairment, behavioral disorders, individual patient characteristics, and type of caregiver. After follow-up of 19 +/- 12 months, 51 patients had been institutionalized. Increased global severity of dementia, the presence of troublesome and disruptive behaviors, and incontinence increased the likelihood of institutionalization. The best predictors of institutionalization were paranoia, aggressive behavior, and incontinence. Neither individual patient characteristics (age, education, and gender) nor caregiver relationship to the patient (male spouse, female spouse, and male or female child) influenced institutionalization. Since troublesome behavioral disorders are potentially treatable aspects of dementia leading to institutionalization, their management should be a major focus of therapy in dementia.

Activities of Daily Living↗

PubMed1987

Institutionalization of Alzheimer's disease patients: reducing precipitating factors through family counseling.

Although home-care of Alzheimer's disease (AD) patients is more cost-effective than institutionalization, there is limited knowledge concerning the causes and prevention of institutionalization. The goal of this project was to determine the circumstances related to institutionalization of AD patients and to determine if a family counseling program can reduce these precipitating factors. In Study 1, we surveyed 109 family members of institutionalized AD patients. Primary precipitating factors included difficulties with patient behavior, insufficient auxiliary help and respite, financial difficulties, and caregiver emotional and physical complaints. In Study 2 we evaluated the effectiveness of an enhanced counseling program which included specific intervention techniques to cope with precipitating factors. For 41 AD family members who were seriously contemplating institutionalization, the precipitating factors prior to counseling were similar to those found in Study 1. After six months of individual counseling, home visits, and participation in caregiver support groups, there was only one placement, and a consistent reduction in the precipitating factors. These preliminary results suggest that a specially designed counseling program may delay or forestall institutionalization.

Alzheimer Disease↗

PubMed1994

Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established Populations for Epidemiologic Studies of the Elderly.

OBJECTIVES: Hip fractures can have devastating effects on the lives of older individuals. We determined the frequency of occurrence of hip fracture and the baseline factors predicting death and institutionalization at 6 months after hip fracture. METHODS: A representative cohort of 2812 individuals aged 65 years and older was followed prospectively for 6 years. Hip fractures were identified, and the occurrence of death and institutionalization within 6 months of the fracture was determined. Prefracture information on physical and mental function, social support, and demographic features and in-hospital data on comorbid diagnoses, fracture site, and complications were analyzed to determine predictors of death and institutionalization after hip fracture. RESULTS: Of 120 individuals suffering a hip fracture, 22 (18%) died within 6 months and 35 (29%) were institutionalized at 6 months. The predictors of death in multiple logistic regression included fracture site, a high number of comorbid conditions, a high number of complications, and poor baseline mental status. The primary predictor of institutionalization was poor baseline mental status. CONCLUSIONS: The frequency of death, institutionalization, and loss of function after hip fracture should prompt a reevaluation of the current approach to this problem.

Activities of Daily Living↗

PubMed2004

[Estimation of the number of institutionalized elderly in Chile].

BACKGROUND: Elderly people (>60 years) in Chile represented 11.4% (n=1,717,478) of the total population in 2002. The group with disabilities or mental problems is increasing and there is no reliable information about the number of institutionalized elderly subjects. AIM: To estimate the number of elderly people living in residences for long term care and their main characteristics. PATIENTS AND METHODS: Chilean Census does not provide exact information about institutional care, therefore we developed a "proxy" indicator of the percentage of institutionalized elderly (those living in "collective residences with more than 5 elderly persons and in which they represent more than 25% of the residents". This proxy has a R2=0.9859 with the true value of institutionalized persons for those Latin-American countries with exact value in census data at CELADE. RESULTS: Using the proxy we found that institutionalized elderly population had increased from 14,114 (1992) to 26,854 (2002) and is projected to reach 83,500 (2025). In 2002, there were 1,668 institutions (37.4% informal care). In the Metropolitan Area, there were 804 institutions (14,178 elderly persons) and 40.3% of these were registered at the Ministry of Health. The proportion of institutionalized elderly subjects was 1.56% of the total elderly population; this proportion increased from 0.87% in subjects 60-74 years old to 2.5% among subjects aged 75-84 years and 6.1% in subjects 85 years old and over. Among subjects living in institutions, 60.9 were women, 21% were married, 35% were single, approximately 50% receive a pension and around 15% were handicapped. CONCLUSIONS: Institutional care affects a small percentage of elderly population, but it will increase in the near future. The main characteristics of institutionalized elderly subjects are not well known. We propose to create a formal Registry of these institutions and to include Nursing Homes and hospitals in type of housing of future Censuses.

Age Distribution↗

PubMed2005

[Factors related to the demand of caregivers for institutionalization of disabled persons living at home].

PURPOSE: Recently, there has been an increase in the number of caregivers who are demanding institutionalization of the disabled, despite having taken care of them at home since their birth. It is important to clarify the background of this demand in order to help develop plans aimed at socially supporting the caregivers. This study was aimed at elucidating the factors related to demands of caregivers to have disabled persons living at home institutionalized. METHODS: To caregivers of 410 home-living disabled persons, we handed out and collected questionnaires asking for the following information: age of the disabled persons and their caregivers, severity of the disability, status and level of manageability of the caregivers, and the place where the caregivers wanted the disabled to live in the future. The demand for institutionalization of the disabled and the attributes of the responders were analyzed by multiple logistic regression. RESULTS: From the responses of 297 people who replied to the questions, univariate analysis revealed that the demand for institutionalization significantly correlated with the labels of "severe" in the mental disability certificate, "incapable of conversation" according to the Office of Population Censuses and Surveys (OPCS) scale, "severe disability" in Oshima's classification and "unfit" and "unable to give daily care." The results analyzed by multiple logistic regression revealed that older caregivers had a significantly higher odds ratio (18.3 for those in their 40s and 37.2 for those in their 50s), indicating a strong correlation between the demand for institutionalization and the age of the caregivers. According to the mental disability certificate, the odds ratio of those with "A" was 5.0 relative to "other than A," while the odds ratio was 3.8 for those "unable to give care" against "able to give care," in both cases statistically significant. As for suffering in daily life, a majority of the caregivers aged 50 years or older claimed "a limit to home caring" and "aging". Regarding the shortage of public welfare services, a large percentage pointed out the inconveniences of emergency short stay, short stay, day care, and bathing services. CONCLUSION: The factors related to demand for institutionalization of disabled care receivers at home were aging of the caregivers, incapability of giving daily care, and severe mental impairment. The age of the caregivers was identified as an explicit factor.

Adolescent↗

PubMed1997

[Predictive factors of institutionalization of dependent elderly persons].

BACKGROUND: This study analyses the factors related to the institutionalization of dependent patients living in the community and receiving informal care from relatives. METHODS: The study is based on a 3-year follow-up of a sample of 205 pairs (carereceiver-caregiver). Eligible care receivers were aged 65 years and over, living at home, and physically or mentally dependent. Caregivers were interviewed at inclusion and three years later in order to know whether the elderly was institutionalized or still living at home. RESULTS: Cox proportional hazards analysis indicated that significant predictors of subsequent institutionalization were intention to institutionalize (p = 0.001), caregiver type (p = 0.015), caregiver's subjective perception of patient behavior problems (p = 0.009), and, at a lesser extent, to live in a urban environment (p = 0.051). The functional status and the carereceiver's age were not predictive of institutionalization. CONCLUSION: This study emphasizes the importance of subjective factors and characteristics of the primary caregiver in predicting institutionalization of elderly dependent persons.

Age Factors↗

PubMed1998

Behavioral modification for institutionalized individuals with urinary incontinence.

OBJECTIVES: To review the evaluation of urinary incontinence (UI) in institutionalized individuals and to discuss the use of behavioral modification in this population. METHODS: The functional characteristics and patterns of incontinence typical of the institutionalized population are described to explain the rationale for the use of behavioral therapies. RESULTS: Both mental and physical status must be evaluated when considering behavioral therapies for UI in institutionalized patients. Institutionalized individuals often have significant functional impairment that prevents the use of behavioral therapies requiring extensive patient participation. Assessments of bladder function and the severity of UI are also important when planning therapy. In appropriate candidates, a prompted voiding program can be expected to reduce the severity of incontinence and improve the quality of life, even though normal bladder control is rarely achieved. Standardized protocols for the implementation of a prompted voiding program have been developed. CONCLUSIONS: Few treatment options for UI are feasible for use in institutionalized individuals. However, prompted voiding can reduce the severity of UI in most of these patients and will thereby improve the quality of life.

Behavior Therapy↗

PubMed2000

Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population.

Risk factors for institutionalization of frail elderly have been studied but the role of nutritional status has not been addressed. A prospective cohort of 288 frail elderly (81 male; 207 female; mean age: 78.2 +/- 7.6 years) were recruited from the current list of those receiving home help services and followed for 3-5 years. At baseline, height, weight, and arm muscle circumference were measured. Self-reported weight loss prior to baseline, energy, and protein intake were recorded. Covariates included sociodemographic factors, social network variables, functional and health status. Cox's multivariate survival analysis was used to identify independent predictors of institutionalization. Over the period of observation, 46% of subjects were institutionalized. Univariate predictors included weight loss >/=5 kg, functional status, and not living alone. In multivariate analysis, weight loss significantly increased the likelihood of institutionalization [Hazard Ratio (HR) = 1.71 (95% CI: 1.08-2.73)] as did limited functional capacities [HR = 1.26 (95% CI: 1.02-1.55)]. Among the free-living frail elderly, weight loss >/=5 kg is an important predictor of early institutionalization after controlling for social network, health, and functional status.

Activities of Daily Living↗

PubMed2005

A prospective study of the effects of behavioral symptoms on the institutionalization of patients with dementia.

BACKGROUND: Reports in the literature on the effects of behavioral problems in patients with dementia on the decision to institutionalize the patient have shown conflicting results. Few studies have taken into account the possibility that specific behavioral problems may have differential effects on the decision to institutionalize the patient. Moreover, it is probably not patient behavior itself that causes nursing home placement (NHP), but caregivers' emotional reaction to it. The aim of the present study was to examine the impact of specific behavioral subsyndromes and caregivers' emotional reaction on NHP. METHODS: A total of 119 patients with dementia and their informal caregivers were followed up for 2 years. Time to NHP was measured in months from the date of the baseline interview to the date of NHP. Behavioral disturbances in the patient and caregivers' emotional reactions were measured with the Neuropsychiatric Inventory (NPI). Cox regression analyses were used to determine the probability that caregivers would institutionalize the patient when patient behavioral problems or caregiver distress were present at baseline. RESULTS: Forty-one percent of the patients were institutionalized during the 2-year follow-;up. Caregiver distress related to patient behavior was a significant predictor of NHP, while behavior in itself did not predict NHP. Contrary to our expectations, we did not find a differential impact of specific aspects of problem behavior. Children caregivers, especially daughters, were associated with shorter time to NHP compared to spouses. CONCLUSIONS: Our findings indicate that the caregiver's emotional reaction to patient behavior is more important than problem behaviors per se in the decision to institutionalize patients. Interventions aimed at teaching caregivers strategies to better manage difficult patient behaviors may provide caregivers with the necessary resources to continue care at home. Future interventions need to account for the specific needs and problems of different caregiver groups.

Aged↗

PubMed2002

Excess mortality or institutionalization after hip fracture: men are at greater risk than women.

OBJECTIVES: To assess 2-year excess mortality or institutionalization risk associated with hip fracture in community-dwelling people aged 60 and over. DESIGN: Cohort study. SETTING: Auckland, New Zealand, from July 1991 to February 1996. PARTICIPANTS: Five hundred sixty-five community-dwelling older people recently hospitalized with a hip fracture and 782 randomly selected controls, frequency matched for age and gender, living in the same catchment area as the cases. MEASUREMENTS: Two-year mortality or institutionalization status. RESULTS: Over half (52.1%) of male hip fracture cases and 12.4% of male controls were dead or institutionalized, compared with 39.2% of female hip fracture cases and 19.7% of female controls. The odds ratio, adjusted for baseline demographic characteristics, medical status, and physical function, for death or institutionalization was 6.89 (95% confidence interval (CI) = 2.75-17.27) for men and 1.48 (95% CI = 1.02-2.19) for women. CONCLUSIONS: For both men and women who incur a hip fracture, the risks of dying or being institutionalized within 2 years are higher than for their peers. The independent effect of hip fracture on this outcome was significantly greater for men than women. The marked influences of prefracture health status, physical limitations, and gender on outcome have important implications for preventative strategies.

Activities of Daily Living↗

PubMed1997

The sizes of the exchangeable pools of selenium in elderly women and their relation to institutionalization.

Exchangeable pools of Se after an intravenous injection of 74Se-enriched isotope as sodium selenite were measured in two groups (n 9) of elderly women (free-living aged 64-82 years and institutionalized aged 68-82 years), and a comparison group (n 9) of young women aged 31-40 years to evaluate the effect of age and institutionalization on Se reserves. Dietary Se intake was not different among the three groups. Plasma Se and glutathione peroxidase (EC 1.11.1.9) levels were significantly lower in the institutionalized elderly women (P < 0.05). In each of the three groups, two pools were determined from our model. The size of the first pool and the sum of the two pools were lower in the group of institutionalized elderly women than in the other two groups. The significant correlation between plasma Se level and total Se pool size (r 0.66, P < 0.01) indicated that this last variable could serve as a new marker of Se status. Finally, these data suggest that the Se status of elderly women is more related to lifestyle, in terms of institutionalization or not, than to age per se.

Adult↗

PubMed2001

Revealing regional differences in the institutionalization of adult patients in homes for the elderly and nursing homes: results of the Belgian network of sentinel GPs.

OBJECTIVES: The aim of this study was, firstly, to determine the number of institutionalizations in homes for the elderly and nursing homes and, secondly, to learn about regional differences in the placement procedure and the pre-existing problems and diseases. METHODS: Data were recorded during 1994 by the 143 GPs of the network of sentinel practices, which is representative of Belgian GPs. All placements of adult patients in homes for the elderly and nursing homes were registered. RESULTS: During 1994, Belgian sentinel GPs placed 297 patients in a nursing home or a home for the elderly. Most of them were women and patients who lived alone. At the time of institutionalization, motor function impairment and dementia were the most common diseases. The institutionalizations were motivated mostly by a need for assistance with daily living activities and nursing assistance. An interim hospitalization was necessary in 60% of all institutionalizations. Two-thirds of all patients were on a waiting list. The average length of these waiting lists was shorter in the southern (Walloon) region than in the northern (Flemish) region. Home care services were consulted in 16% of all institutionalizations. In the southern region, home care services were consulted more often than in the northern region. CONCLUSIONS: Motor function impairment and dementia were the most common pre-existing impairments. Placements were often hampered by long waiting lists and interim hospitalization. In the southern region, waiting lists were shorter and home care services consulted more often. Some placements could be avoided or delayed by a better organization and promotion of the possibilities of professional home care services.

Aged↗

PubMed2000

An estimate of long-term care needs and identification of risk factors for institutionalization among Hong Kong Chinese aged 70 years and over.

BACKGROUND: The goal of this study is to estimate the long-term care needs of the Hong Kong Chinese population age 70 years and older, and to identify risk factors for institutionalization. METHODS: A three-year prospective follow-up study was carried out in Hong Kong Special Administrative Region, China. 2,032 subjects aged 70 years and older were recruited territory-wide by stratified random sampling of the Old Age and Disability Allowance register, covering over 90% of the elderly population. A questionnaire was administered at baseline to obtain information on social, functional, physical, and mental health status, and place of residence. A repeat interview was carried out at 36 months. The number of subjects moving from home to institution or vice versa, and the number who had died, were noted. Univariate analysis was performed to determine risk factors for institutionalization, and backward stepwise multiple logistic regression was used to identify independent factors predisposing to institutionalization. RESULTS: The institutionalization rate per year is estimated to be 0.7% for the 70-79 age group, and 1.5% for the 80+ age group. Using population figures projected by the Hong Kong Census, the corresponding number of places required will be 24,150 and 42,000, respectively, for the two age groups by 2005, whereas the number of government subvented places projected to be available is unlikely to be more than 40,000 for the whole population. Age, being a woman, being single, not having a formal education, cognitive impairment, physical dependency, and the presence of depressive symptoms were factors predisposing to institutionalization. In multivariate analysis, age, marital status, and dependency were identified as independent factors. CONCLUSION: The requirement for institutional places is unlikely to be met by government, the shortfall likely to be met by the private sector. Maintenance of functional independence, good social support network, engagement in social activities, and good informal carer support may reduce demand for institutional care.

Activities of Daily Living↗

PubMed2001

Factors associated with long-term institutionalization of older people with dementia: data from the Canadian Study of Health and Aging.

BACKGROUND: In Canada, half the people with dementia live in institutions. Factors associated with institutionalization should be identified with the goal of implementing strategies not only to permit those with dementia to stay in their homes as long as is feasible but also to ensure that steps are taken for timely institutionalization when appropriate. METHODS: Informal caregivers of 326 individuals with dementia living in the community were identified and interviewed as part of the Canadian Study of Health and Aging (CSHA). These subjects were contacted again 2.5 and 5 years after the baseline interview to collect information on the status of their care recipients. Survival analyses using clinical data for the individuals with dementia and data from the interviews with their informal caregivers were carried out using Cox proportional hazard modeling to estimate the hazard ratio (HR). RESULTS: Over the 5-year period, 166 individuals with dementia (50.9%) were institutionalized and the median time to admission was 41 months. From the multivariate analysis, the factors significantly associated with institutionalization were: type of dementia (Alzheimer's disease: HR = 1.83), severity of disability (mild: 1.51; moderate: 2.34; total impairment: 4.02), caregiver's age over 60 (1.83), caregiver not a spouse or child (1.55), and severe caregiver burden (1.71). Caregiver's burden was associated with the care-receiver's behavioral disturbance (partial r =.55) and the caregiver's depressive mood (r =.55). CONCLUSIONS: Screening caregivers for burden and depression and designing interventions to decrease the consequences of behavioral disturbance on caregivers would be relevant avenues to explore to decrease institutionalization of people with dementia.

Aged↗

PubMed1990

Predictors of institutionalization among Alzheimer disease victims with caregiving spouses.

A theoretical model predicting "desire to institutionalize" and actual institutionalization was developed and tested on a sample of 220 persons caring for a demented spouse. Significant predictors of "desire to institutionalize" include age and education of caregiver, spouse's forgetful behaviors, ADL tasks done by the caregiver, medications taken by the caregiver, services used, and quality of relationship with spouse. Predictors of actual institutionalization are desire to institutionalize, length of time spent as a caregiver, religion, uplifts, and forgetful behaviors of the impaired spouse.

Aged↗

PubMed1994

Area of residence and the risk of institutionalization.

Many of the sociodemographic, health status, and social support characteristics that predict the use of health services by elders vary by area of residence. Yet, little is known about how these factors affect the risk of institutionalization in rural, small city, and urban areas. The purpose of this research was to: (a) determine the rate of institutionalization over a two-year period for impaired community-dwelling elders in rural, small city, and urban areas; (b) test for residence differences in sociodemographic, health status, and social support characteristics likely to influence the risk of institutionalization; and (c) examine their effect on the probability of being institutionalized in each area of residence. Although rural elders are less likely to be placed in a nursing home than their small city or urban counterparts, race and level of impairment affect the risk of institutionalization more in rural than in urban areas.

Aged↗