Presence of behavioral and psychological symptoms predicts nursing home placement in community-dwelling elders with cognitive impairment in univariate but not multivariate analysis

Abstract

Background. The role of behavioral and psychological symptoms as an independent risk factor of nursing home placement (NHP) in cognitively impaired elders has been controversial. Methods. A community sample of 449 cognitively impaired elders and their knowledgeable informants (KIs) was followed for 1 year. Subjects were classified as having dementia (n = 330) or mild cognitive impairment (MCI) (n = 119) using a neuropsychiatric battery of 4 tests. Subject characteristics (behavioral and psychological symptoms, demographic, health related, and health services use) and KI characteristics were entered into the Cox proportional hazard regression analysis. Results. The incidence rate of NHP was 8.9%. At baseline, 57.7% of subjects had at least 1 behavioral and psychological symptom. Presence of these symptoms was associated with shorter time to NHP only in a univariate analysis. Other factors significant in the multivariate Cox modeling were being white (hazard ratio [HR] = 2.17), having fair or poor physical health rating (HR = 2.12), having greater numbers of difficulties with activities of daily living (HR = 1.46), and having a physician's diagnosis of dementia (HR = 6.76). An interaction was found between the last 2 variables (HR = 0.59), indicating that among those with a diagnosis of dementia, a greater number of difficulties with activities of daily living delayed time to NHP. KI characteristics were not associated with NHP. Conclusions. Behavioral and psychological symptoms were common, but having these symptoms was not an independent risk factor of NHP. Caregiver characteristics may not play as important a role in determining NHP as subject characteristics. Interventions aimed at improving or maintaining physical or cognitive functioning may have better chances of delaying NHP.