Marine Dufournet1, Virginie Dauphinot2, Claire Moutet1, Mathieu Verdurand1, Floriane Delphin-Combe1, Pierre Krolak-Salmon3. 1. Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France. 2. Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France. Electronic address: virginie.dauphinot@chu-lyon.fr. 3. Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Lyon Institute for Elderly, Hospices civils de Lyon, Lyon, France; Research Clinic Centre (CRC)-VCF (Aging Brain Frailty), Lyon Institute For Elderly, Hospices civils de Lyon, Lyon, France; University Lyon 1, INSERM, U1028, UMR CNRS 5292, Research Centre of Neurosciences of Lyon, Lyon, France.
Abstract
OBJECTIVES: To estimate the attributable fraction of nursing home placement associated with cognitive impairment, neuropsychiatric symptoms, behavioral disorders, functional limitations, and caregiver burden. DESIGN: Longitudinal study conducted on the "MEMORA cohort" linked with both regional public health insurance and hospital discharge databases. SETTING: Memory center at the University Hospital of Lyon, France. PARTICIPANTS: A sample of 2456 outpatients attending the memory center between 2012 and 2017. MEASURES: Cognitive impairment, functional limitations, neuropsychiatric symptoms/behavioral disorders, and caregiver burden were measured with the Mini-Mental State Examination, the Instrumental Activities of Daily Living scale, the Neuropsychiatric Inventory (NPI), and a short version of the Zarit Burden Inventory, respectively. Sociodemographics characteristics were collected during the first visit. Comorbidities were gathered from the hospital discharge database. Dates of nursing home placement were obtained from the public health insurance database. RESULTS: More than 38% of nursing home placements were attributable to caregiver burden, and the attributable fraction associated with functional limitations exceeded 35%. Between 20% and 25% of nursing home placements were due to cognitive impairment whereas less than 16% were attributable to neuropsychiatric symptoms or behavioral disorders. The associations between anxiety or agitation and nursing home placement were mediated by caregiver burden. Apathy or aberrant motor behaviors were associated with a higher risk of nursing home placement independently of caregiver burden. CONCLUSIONS/IMPLICATIONS: Our findings suggest that a high proportion of nursing home placements are attributable to caregiver burden and functional limitations in outpatients attending a memory center. Cognitive impairment and neuropsychiatric symptoms or behavioral disorders contribute less to nursing home placements. Interventions directed to delay nursing home placement should emphasize actions toward reducing caregiver burden and functional limitations of patients.
OBJECTIVES: To estimate the attributable fraction of nursing home placement associated with cognitive impairment, neuropsychiatric symptoms, behavioral disorders, functional limitations, and caregiver burden. DESIGN: Longitudinal study conducted on the "MEMORA cohort" linked with both regional public health insurance and hospital discharge databases. SETTING: Memory center at the University Hospital of Lyon, France. PARTICIPANTS: A sample of 2456 outpatients attending the memory center between 2012 and 2017. MEASURES: Cognitive impairment, functional limitations, neuropsychiatric symptoms/behavioral disorders, and caregiver burden were measured with the Mini-Mental State Examination, the Instrumental Activities of Daily Living scale, the Neuropsychiatric Inventory (NPI), and a short version of the Zarit Burden Inventory, respectively. Sociodemographics characteristics were collected during the first visit. Comorbidities were gathered from the hospital discharge database. Dates of nursing home placement were obtained from the public health insurance database. RESULTS: More than 38% of nursing home placements were attributable to caregiver burden, and the attributable fraction associated with functional limitations exceeded 35%. Between 20% and 25% of nursing home placements were due to cognitive impairment whereas less than 16% were attributable to neuropsychiatric symptoms or behavioral disorders. The associations between anxiety or agitation and nursing home placement were mediated by caregiver burden. Apathy or aberrant motor behaviors were associated with a higher risk of nursing home placement independently of caregiver burden. CONCLUSIONS/IMPLICATIONS: Our findings suggest that a high proportion of nursing home placements are attributable to caregiver burden and functional limitations in outpatients attending a memory center. Cognitive impairment and neuropsychiatric symptoms or behavioral disorders contribute less to nursing home placements. Interventions directed to delay nursing home placement should emphasize actions toward reducing caregiver burden and functional limitations of patients.
Authors: Antonio Terracciano; Ashley Artese; Jenie Yeh; LaVon Edgerton; Lisa Granville; Damaris Aschwanden; Martina Luchetti; Robert L Glueckauf; Yannick Stephan; Angelina R Sutin; Paul Katz Journal: J Am Med Dir Assoc Date: 2019-12-19 Impact factor: 4.669