Predictors of Nursing Home Placement in a Cohort of European People with Alzheimer’s Disease and Other Dementia Cases Enrolled in SCU-B or Non SCU-B Centers: The RECage Study

Article type: Research Article

Authors: Cesana, Bruno Mario^{a; *} | Bergh, Sverre^b | Ciccone, Alfonso^c | Cognat, Emmanuel^d | Fabbo, Andrea^e | Fascendini, Sara^f | Frisoni, Giovanni B.^g | Froelich, Lutz^h | Handels, Ronⁱ | Jori, Maria Cristina^j | Mecocci, Patrizia^{k; l} | Merlo, Paola^m | Peters, Oliverⁿ | Tsolaki, Magda^{o; p} | Defanti, Carlo Alberto^f

Affiliations: [a] Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics “Giulio A. Maccacaro” Faculty of Medicine and Surgery, University of Milan, Milan, Italy | [b] Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway (SCU-B) | [c] Department of Neurology with Neurosurgical Activity “Carlo Poma” Hospital, ASST di Mantova, Mantua, Italy (non-SCU-B) | [d] Cognitive Neurology Centre, Lariboisière-Fernand Widal Hospital GHU AP-HP Nord, Université Paris-Diderot, Paris, France (non-SCU-B) | [e] Department of Primary Care, Geriatric Service-Cognitive Disorders and Dementia, Local Health Authority of Modena (AUSL), Modena, Italy (SCU-B) | [f] FERB Alzheimer Centre, Gazzaniga, Italy (SCU-B) | [g] Division of Geriatrics and Rehabilitation, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland (SCU-B) | [h] Department of Geriatric Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany (SCU-B) | [i] Department of Psychiatry and Neuropsychology, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands | [j] Mediolanum Cardio Research, Milan, Italy | [k] Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy | [l] NVS Department, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden (non-SCU-B) | [m] Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, Bergamo, Italy (non-SCUB) | [n] Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany (non SCU-B) | [o] Greek Association of Alzheimer’s Disease and Related Disorders (GAADRD), Thessaloniki, Greece | [p] First Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece

Correspondence: [*] Correspondence to: Bruno Mario Cesana, Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics “Giulio A. Maccacaro” Faculty of Medicine and Surgery, University of Milan, Via Celoria 22, 20133, Milan, Italy. Tel.: +039 (0)2 50320883; E-mail: [email protected].

Abstract: Background:Nursing home placement (NHP) can be the final step of patients with Alzheimer’s disease. Objective:We aimed to identify NHP predictors among 508 people with dementia with a 3-year follow-up. Methods:We analyzed data from the international observational RECage study, involving 508 people with especially Alzheimer’s disease and comparing a cohort enrolled by five centers with a Special Care Unit for BPSD (behavioral and psychological symptoms of dementia) and another one enrolled by six centers lacking this facility. The tertiary objective of the study was to assess the possible role of the SCU-B in delaying NHP. We assessed the relationship of the baseline characteristics with NHP by means of univariate analysis followed by Cox’s multivariate model. Results:Patients’ mean age was 78.1 years, 54.9% were women. Diagnosis mean age was 75.4 (±8.32) years; the main diagnosis was Alzheimer’s disease (296; 58.4%). During follow-up, 96 (18.9%) patients died and 153 (30.1%) were institutionalized without a statistically significant difference between the two cohorts (p = 0.9626). The mean NHP time was 902 (95% CI: 870–934). The multivariable analysis without death as a competing risk retained four independent predictors of NHP: age increase (hazard ratio (HR) = 1.023, 95% CI: 1.000–1.046), patient education level increase (HR = 1.062, 95% CI: 1.024–1.101), Neuropsychiatric Inventory total increase (HR = 1.018; 95% CI: 1.011–1.026), and total Mini-Mental State Examination as a favorable factor (HR = 0.948, 95% CI: 0.925–0.971). Gender (females versus males: HR = 1.265, 95% CI: 0.899–1.781) was included in the final Cox’s model for adjusting the estimates for. Conclusions:Our data partially agree with the predictors of NHP in literature including the effect of high education level. No caregivers’ factors were statistically significant. Clinical trial registration:NCT03507504.

Keywords: Alzheimer’s disease, dementia, nursing home placement, predictive factors

DOI: 10.3233/JAD-230878

Journal: Journal of Alzheimer's Disease, vol. 98, no. 3, pp. 1043-1052, 2024