Risk factors of institutionalization in an elderly disabled population

Due to increased life expectancy and demographic ageing an increasingnumber of elderly people have to spend the eve of their lifein institutional settings, which is often associated with adversepsychosocial and financial consequences. The purpose of thisprospective study is to assess the extent and determinants ofinstitutionalization in a population sample of severely disabledelderly people from south Germany. The study population includedall non-institutionalized persons in a defined region who metthe criteria of permanent nursing dependency set by the Germanstatutory health insurance system. Study participants were recruitedin 1991–1993 and followed for a mean of 1.7 years. Rateratios of Institutionalization for potential risk factors werecalculated using Cox's proportional hazards model. Out of 1,583study participants 159 aged 60 years or older were admittedto a nursing home during the follow-up period. Old age, femalegender, living In urban compared to rural areas, professionalprovider of nursing care compared to family members as maincare givers and cognitive impairments independently increasedthe rate of institutionalization In multivariable analysis.There was no relationship between limitations in basic activitiesof daily living and the rate of institutionalization. Theseempirical data extend the scarce database in Germany, whichis needed for further planning of nursing care facilities inthe community in order to improve the situation of disabledpeople, in particular to prevent nursing home admission.