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Nursing Home Decisions Should Factor in Caregivers
Wed Apr 24, 1:27 PM ET

By Alison McCook

NEW YORK (Reuters Health) - Most elderly patients with dementia eventually enter nursing homes, with such decisions typically dependent on the severity of the illness or the health and availability of the caregiver. Now, new research shows that the best predictor of nursing home placement is actually a combination of patient and caregiver factors.

The study results, presented in the April 24th issue of The Journal of the American Medical Association (news - web sites), are based on findings from 5,788 patients with dementia and theircaregivers, followed over a 3-year period.

Dr. Kristine Yaffe of the University of California, San Francisco, and colleagues looked at patient characteristics such as age, ethnicity, independence and whether or not the patient was living alone. They also examined caregiver qualities including age, relationship to the patient and annualincome.

Caregivers who felt a high burden from taking care of the demented patient--manifested as stress or a lot of time spent with the patient--were more likely than other caregivers to enroll the patient in a nursing home within a 3-year period. And patients who displayed certain difficult behaviors, such as aggression or waking up their caregivers, were more likely to enter a nursing home than patients without those traits, the report indicates.

"That really takes a tremendous toll on the caregiver," Yaffe told Reuters Health in an interview.

Overall, however, nursing home placement was best predicted by a combination of patient and caregiver traits. The likelihood of a patient entering a nursing home also related to ethnicity, with black and Hispanic patients significantly less likely than whites to move into a nursing home. In addition, patients whose primary caregiver was a husband, daughter or daughter-in-law were more likely than others to stay at home.

Postponing enrollment in nursing homes saves the healthcare system a significant amount of money, but Yaffe said that prolonging home care may not be the best solution for all families. She suggested that policymakers should consider paying caregivers while they continue to care for patients, since keeping patients at home saves the government money.

SOURCE: The Journal of the American Medical Association 2002;287:2090-