TY - JOUR
T1 - Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly
AU - Friedman, Susan M.
AU - Steinwachs, Donald M.
AU - Temkin-Greener, Helena
AU - Mukamel, Dana B.
N1 - Funding Information:
The Dementia Care Networks’ Study was funded by the Canadian Health Services Research Foundation and the Ontario Ministry of Health and Long-Term Care (grant number RC 1-0229-06). We acknowledge the genuine support of each network in the pilot testing of instruments, the recruitment of care recipients and caregivers, and the completion of survey instruments. Address correspondence to Dr. Louise Lemieux-Charles, Department of Health Policy, Management and Evaluation, University of Toronto, McMurrich Building, 12 Queen’s Park Crescent West, Toronto, ON M5S 1A8, Canada. E-mail: l.lemieux.charles@utoronto.ca 1Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada. 2Elisabeth Bruyère Research Institute, Ottawa, ON, Canada. 3Department of Physical Therapy, University of Toronto, ON, Canada. 4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 5Department of Psychiatry, University of Toronto, ON, Canada. 6Division of Geriatric Psychiatry, Queen’s University, Kingston, ON, Canada. 7Division of Geriatric Medicine, University of Ottawa, ON, Canada. 8SCO Health Service, Ottawa, ON, Canada.
PY - 2006/8
Y1 - 2006/8
N2 - Purpose: We sought to determine whether participants in the Program of All-Inclusive Care for the Elderly (PACE) with an informal caregiver have a higher or lower risk of nursing home admission than those without caregivers. Design and Methods: We performed a secondary data analysis of 3,189 participants aged 55 years or older who were enrolled in 11 PACE programs during the period from June 1, 1990 through June 30, 1998. Cox proportional hazard models determined whether having any caregiver, as well as specific caregiver characteristics, such as either living separately from the enrollee, being over the age of 75 years, providing personal care, not reducing or quitting work to provide care, or not being a spouse, predicted time to nursing home admission. Results: Fewer than half of the participants (49.4%) lived with a caregiver, and 12.4% had no caregiver. Individuals who lived with their caregiver were frailer than either those who lived separately or those without a caregiver. We measured frailty in terms of functional and cognitive status, incontinence, and multiple behavioral disturbances. The presence of a caregiver did not change the risk for institutionalization. None of the caregiver characteristics were associated with a higher risk of nursing home admission. Implications: Unlike individuals in the general population, participants in PACE who lack an informal caregiver are not at higher risk of institutionalization. Further research is required to ascertain whether PACE's comprehensive formal services compensate for the lack of informal caregiving in limiting the risk for institutionalization.
AB - Purpose: We sought to determine whether participants in the Program of All-Inclusive Care for the Elderly (PACE) with an informal caregiver have a higher or lower risk of nursing home admission than those without caregivers. Design and Methods: We performed a secondary data analysis of 3,189 participants aged 55 years or older who were enrolled in 11 PACE programs during the period from June 1, 1990 through June 30, 1998. Cox proportional hazard models determined whether having any caregiver, as well as specific caregiver characteristics, such as either living separately from the enrollee, being over the age of 75 years, providing personal care, not reducing or quitting work to provide care, or not being a spouse, predicted time to nursing home admission. Results: Fewer than half of the participants (49.4%) lived with a caregiver, and 12.4% had no caregiver. Individuals who lived with their caregiver were frailer than either those who lived separately or those without a caregiver. We measured frailty in terms of functional and cognitive status, incontinence, and multiple behavioral disturbances. The presence of a caregiver did not change the risk for institutionalization. None of the caregiver characteristics were associated with a higher risk of nursing home admission. Implications: Unlike individuals in the general population, participants in PACE who lack an informal caregiver are not at higher risk of institutionalization. Further research is required to ascertain whether PACE's comprehensive formal services compensate for the lack of informal caregiving in limiting the risk for institutionalization.
KW - Informal support
KW - Institutionalization
KW - PACE
KW - Social support
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U2 - 10.1093/geront/46.4.456
DO - 10.1093/geront/46.4.456
M3 - Article
C2 - 16920999
AN - SCOPUS:33748670268
SN - 0016-9013
VL - 46
SP - 456
EP - 463
JO - Gerontologist
JF - Gerontologist
IS - 4
ER -