Predictors of nursing home placement at 2 years in Alzheimer's disease: A follow‐up survey from the THERAD study

• Published in: International journal of geriatric psychiatry 2022-06, Vol.37 (6), p.n/a
• Main Authors: Villars, Hélène, Gardette, Virginie, Frayssignes, Pauline, Deperetti, Eva, Perrin, Amélie, Cantet, Christelle, Soto‐Martin, Maria
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Autonomy; burden; Caregivers; Clinical trials; Dementia; Dementia disorders; dyadic approach; Geriatric psychiatry; Life Sciences; Neurodegenerative diseases; nursing home; Nursing homes; Offspring; offspring caregivers; Patient education; Risk factors
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.5724

Objectives Nursing Home Placement (NHP) can prove to be the only solution to some dead‐end situations in Alzheimer's disease (AD). The predictors of NHP are known and can be related to either the person with dementia or his/her caregiver. We aimed to identify predictors of NHP among people with AD over a 2‐year follow‐up period, with a particular interest in the modifiable predictors, notably those involving caregivers. Methods We studied data from the THERAD study, a French monocentric randomized controlled trial, involving 196 community‐dwelling dyads, primarily assessing an educational intervention in AD. We performed a bivariate analysis followed by a multivariate Cox model, with a backward stepwise procedure. Results The mean age of the patients was 82 years old, 67.7% were women and 56.9% were living with a partner. The mean age of the caregivers was 65.8 years old, 64.6% were women and half were spouses of the patients with a moderate burden. During the follow‐up, 23 patients died and 49 were institutionalized. The majority of NHPs occurred during the first year (35 NHP). The mean time to NHP was 27.77 months after the diagnosis. Five independent predictors of NHP were found: a higher patient education level (aHR 6.31; CI95% = 1.88–21.22), a high caregiver Burden (aHR 3.97; CI95% = 1.33–11.85), the caregiver being the offspring of the patient (aHR 2.92; CI95% = 1.43–5.95), loss of autonomy (aHR 2.75; CI95% = 1.13–6.65) and disinhibition as a behavioural and psychological symptoms of dementia (BPSD) (aHR 2.38; CI95% = 1.26–4.47). Conclusions Our data are in accordance with the literature in identifying loss of autonomy, burden and BPSD (disinhibition) as risk factors of NHP. We also found high patient education level and status of offspring caregiver as additional factors. It is essential to take into account the caregiver status when designing psychoeducational trials aiming to delay NHP. Further studies need to take into account both the modifiable risk factors related to the patient (productive BPSD) and the needs of offspring caregivers (work–life balance, mental load). Key points Nursing home placement (NHP) can be the only solution in some dead‐end situations in Alzheimer's disease (AD). There is some evidence on the risk factors of NHP, related to both patients and caregivers (behavioural and psychological symptoms, loss of autonomy, and caregiver burden). We found these factors in our work on a sample of 196 dyads during a 2‐year follow‐up as