Home and Community Care Digest

Home and Community Care Digest September 2004 : 0-0

Factors associated with nursing home admission differ between women and men with Alzheimer's

Abstract

This study examined patterns of nursing home admission for women and men with Alzheimer's disease in the USA. The results demonstrate some evidence of gender differences in patterns of admission. In comparison to men, women who were institutionalized were healthier, had less cognitive loss and fewer behavioral problems, while their placement was more strongly influenced by family care patterns such as the caregiver's intent to seek an end to home care and their previously expressed intention to institutionalize.
Background: Women represent 75-80% of nursing home residents, and a significant proportion of people with dementia. Most predictive models of institutionalization focus on medical factors such as physical and mental limitations but do not investigate the impact of gender on nursing home admission. This American study sought to identify family care, medical, and demographic factors that account for higher rates of nursing home admission among women with Alzheimer's disease.

Method: A two-year, four-wave follow-up study was conducted with 573 Alzheimer patients and their primary caregivers. At the beginning of the study, patients underwent cognitive functioning tests, measuring physical, cognitive and behavioural impairment. Caregivers were administered an in-home questionnaire assessing family caregiving factors such as caregiving burden, intention to institutionalize, and family support level. Three follow-up telephone surveys were conducted at six-month intervals.

Findings: After controlling for age, women were less likely to continue with home care (45% vs 64%), and more likely to be institutionalized (30% versus 26%) than were men. Three factors predicted nursing home admission for women: more activities of daily living (ADL) deficits, greater memory impairment, and a caregiver's previously expressed intention to institutionalize. Six factors predicted institutionalization for men: the same three for women, plus behavioral impairment, fewer weekly hours of care, and reduced social support for caregivers.

Conclusion: The study demonstrates some evidence for gender differences in nursing home admission for women with Alzheimer's disease. In comparison to men, women who were institutionalized were healthier, had less cognitive loss and fewer behavioral problems. Factors that influenced the decisions to place women in institutions showed the importance of family care patterns such as the caregiver's intent to seek an end to home care, and their previously expressed intention to institutionalize. This may suggest that women with Alzheimer's may be more vulnerable to institutional placement based on factors associated with family care rather than health deficits.

Reference: Young, RF, Rosalie F. "Nursing home admission of female Alzheimer's patients: Family care aspects". Women's Health Issues 13, 2003: 2-7.

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