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Age and Ageing Advance Access published online on November 23, 2009
Age and Ageing, doi:10.1093/ageing/afp202
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© The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Systematic Review

Prediction of institutionalization in the elderly. A systematic review

Melanie Luppa1, Tobias Luck1, Siegfried Weyerer2, Hans-Helmut König3, Elmar Brähler4 and Steffi G. Riedel-Heller5

1 Department of Psychiatry and Psychotherapy, Public Health Research Unit, University of Leipzig, Germany
2 Central Institute of Mental Health, Mannheim, Germany
3 Department of Psychiatry and Psychotherapy, Health Economics Research Unit, University of Leipzig, Germany
4 Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
5 Department of Psychiatry and Psychotherapy, Public Health Research Unit and Department of Social Medicine, University of Leipzig, Germany

Address correspondence to: M. Luppa. Email: Melanie.Luppa{at}medizin.uni-leipzig.de

Objective: in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general population of developed countries.

Design: relevant articles were identified by searching the databases MEDLINE, Web of Science, Cochrane Library and PSYNDEXplus. Studies based on population-based samples with prospective study design and identification of predictors by multivariate analyses were included. Quality of studies and evidence of predictors were determined.

Results: thirty-six studies were identified; one-third of the studies were of high quality. Predictors with strong evidence were increased age, low self-rated health status, functional and cognitive impairment, dementia, prior NHP and a high number of prescriptions. Predictors with inconsistent results were male gender, low education status, low income, stroke, hypertension, incontinence, depression and prior hospital use.

Conclusions: findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living. However, the methodical quality of studies needs improvement. More theoretical embedding of risk models of NHP would help to establish more clarity in complex relationships in using nursing homes.

Keywords: institutionalization, nursing home placement, nursing home admission, systematic review, old age, NHA, elderly

Received 28 April 2009; accepted in revised form 22 September 2009.


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