Predictors of nursing home admission for persons with dementia

Objective: The objective of this systematic review was to identify factors that consistently predict nursing home admission (NHA) in persons with dementia. Methods: Studies published in English were retrieved by searching the MEDLINE (1966-2006), PSYCINFO (1950-2006), CINAHL (1982-2006), and Digital Dissertations (1950-2006) databases. Bibliographies of retrieved studies were also searched. Information on study characteristics and empirical results were extracted using a standardized protocol. Results: Of 782 relevant studies identified 80 were selected for review based upon eligibility criteria. The most consistent predictors of NHA in persons with dementia included severity of cognitive impairment, Alzheimer disease diagnosis, basic activity of daily living dependencies, behavioral symptoms, and depression. Caregivers who indicated greater emotional stress, a desire to institutionalize the care recipient, and feelings of being "trapped" in care responsibilities were more likely to admit persons with dementia to nursing homes. Demographic variables, incontinence, and service use did not consistently predict NHA. Conclusions: Several results seemed to challenge conventional assumptions of what precipitates NHA among persons with dementia. Caregiver stressors in conjunction with care recipient characteristics are important to consider when assessing NHA risk. The findings emphasize the need to construct more complex models of institutionalization when designing risk measures to target interventions.