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Nursing home placement associated with accelerated cognitive decline in Alzheimer's disease
Jun 4, 2007 - 4:00:00 PM
, Reviewed by: Dr. Himanshu Tyagi
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Patients who had prior adult day care services may be better able to adjust to the unfamiliar environment.
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Level of Evidence
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2b - Individual Cohort Study
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Key Points of this article
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The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer's disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.
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On average, cognition declined at a gradually increasing rate for all participants.
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As level of day care use at study onset increased, the association of nursing home placement with accelerated cognitive decline substantially decreased.
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People using day care 3 to 4 days a week at the beginning of the study showed no increase in cognitive decline upon nursing home placement.
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Main results
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The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer's disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living.
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By Rush University Medical Center,
[RxPG] People with Alzheimer's disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by Rush University Medical Center. The study, published in the June issue of the American Journal of Psychiatry, finds that prior experience in adult day care may lessen this association.
The observational study involved 432 older persons with Alzheimer's disease who were recruited from health care settings in the Chicago area. At baseline, they lived in the community and 196 participants were using day care services from 2 to 6 days a week for an overall mean of 1.7 days a week. At six month intervals for up to four years, they completed nine cognitive tests from which a composite measure of global cognition was derived.
On average, cognition declined at a gradually increasing rate for all participants. During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.
Study participants who had previous adult day care experience fared better. As level of day care use at study onset increased, the association of nursing home placement with accelerated cognitive decline substantially decreased. Thus, people using day care 3 to 4 days a week at the beginning of the study showed no increase in cognitive decline upon nursing home placement.
The findings suggest that experience in day care may help individuals with Alzheimer's disease make the transition from the community to institutional residence, said study author Robert S. Wilson, Ph.D., a neuropsychologist at the Rush Alzheimer's Disease Center.
The study also found that a higher level of education was associated with accelerated cognitive decline upon nursing home placement. Yet, day care use markedly reduced the association of education with accelerated cognitive decline in the nursing home; further evidence that there is a robust association between day care experience and cognition during the transition to a nursing home.
The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer's disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.
Alternatively, the increased cognitive decline upon placement may reflect difficulty adapting to an unfamiliar environment, consistent with clinical reports of increased confusion and behavior problems in those with dementia during acute hospitalization or trips away from home. Patients who had prior adult day care services may be better able to adjust to the unfamiliar environment.
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About Dr. Himanshu Tyagi
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This news story has been reviewed by Dr. Himanshu Tyagi before its publication on RxPG News website. Dr. Himanshu Tyagi, MBBS is the founder editor and manager for RxPG News. In this position he is responsible for content development and overall website and editorial management functions. His areas of special interest are psychological therapies and evidence based journalism.
RxPG News is committed to promotion and implementation of Evidence Based Medical Journalism in all channels of mass media including internet.
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