Predictors of Institutionalization in Patients with Alzheimer’s Disease in South Korea
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Background and Purpose We investigated predictors of institutionalization in patients withAlzheimer’s disease (AD) in South Korea. Methods In total, 2,470 patients with AD aged 74.5±7.8 years (mean±standard deviation,68.1% females) were enrolled from November 2005 to December 2013. The dates of institutionalizationwere identified from the public Long-Term-Care Insurance program in January 2014. We used a Cox proportional-hazards model to identify predictors for future institutionalizationamong characteristics at the time of diagnosis in 2,470 AD patients. A similar Cox proportionalhazardsmodel was also used to investigate predictors among variables that reflected longitudinalchanges in clinical variables before institutionalization in 816 patients who underwent follow-up testing. Results A lower Mini Mental State Examination score [hazard ratio (HR)=0.95, 95% confidenceinterval (CI)=0.92–0.97] and higher scores for the Clinical Dementia Rating and Neuro-Psychiatric Inventory (HR=1.01, 95% CI=1.00–1.01) at baseline were independent predictors ofinstitutionalization. The relationship of patients with their main caregivers, presence of the apolipoproteinE e4 allele, and medication at baseline were not significantly associated with the rateof institutionalization. In models with variables that exhibited longitudinal changes, larger annualchange in Clinical Dementia Rating Sum of Boxes score (HR=1.15, 95% CI=1.06–1.23)and higher medication possession ratio of antipsychotics (HR=1.89, 95% CI=1.20–2.97) predictedearlier institutionalization. Conclusions This study shows that among Korean patients with AD, lower cognitive ability,higher dementia severity, more-severe behavioral symptoms at baseline, more-rapid decline in dementiaseverity, and more-frequent use of antipsychotics are independent predictors of earlier institutionalization.
Abstract
Background and Purpose We investigated predictors of institutionalization in patients withAlzheimer’s disease (AD) in South Korea. Methods In total, 2,470 patients with AD aged 74.5±7.8 years (mean±standard deviation,68.1% females) were enrolled from November 2005 to December 2013. The dates of institutionalizationwere identified from the public Long-Term-Care Insurance program in January 2014. We used a Cox proportional-hazards model to identify predictors for future institutionalizationamong characteristics at the time of diagnosis in 2,470 AD patients. A similar Cox proportionalhazardsmodel was also used to investigate predictors among variables that reflected longitudinalchanges in clinical variables before institutionalization in 816 patients who underwent follow-up testing. Results A lower Mini Mental State Examination score [hazard ratio (HR)=0.95, 95% confidenceinterval (CI)=0.92–0.97] and higher scores for the Clinical Dementia Rating and Neuro-Psychiatric Inventory (HR=1.01, 95% CI=1.00–1.01) at baseline were independent predictors ofinstitutionalization. The relationship of patients with their main caregivers, presence of the apolipoproteinE e4 allele, and medication at baseline were not significantly associated with the rateof institutionalization. In models with variables that exhibited longitudinal changes, larger annualchange in Clinical Dementia Rating Sum of Boxes score (HR=1.15, 95% CI=1.06–1.23)and higher medication possession ratio of antipsychotics (HR=1.89, 95% CI=1.20–2.97) predictedearlier institutionalization. Conclusions This study shows that among Korean patients with AD, lower cognitive ability,higher dementia severity, more-severe behavioral symptoms at baseline, more-rapid decline in dementiaseverity, and more-frequent use of antipsychotics are independent predictors of earlier institutionalization.
참고문헌 (32)
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