Baseline differences and trajectories of change for deceased, placed, and community residing Alzheimer disease patients
Home Care Services
This study identifies predictors of placement or death in a large ethnically/racially diverse sample of moderately impaired Alzheimer disease patients residing in the community. Patients and caregivers were followed for 18 months with 4 assessments at 6-month intervals. Multinomial regression was used to identify caregiver and patient baseline characteristics and changes over time as predictors of patient placement in a long-term care facility (n=180), patient death (not preceded by placement, n=187), or remaining in the community at home (n=583). Our findings reveal important differences between death and placement when compared with continued home care. Both death and placement are significantly associated with increased activities of daily living limitations (Exp(B)=1.285, P=0.017; Exp(B)=0.1.202, P=0.038, for death and placement, compared with home care, respectively), having a nonspouse caregiver [Exp(B)=0.325, P=0.026; Exp(B)=0.386, P=0.050, for death and placement, respectively], and being a male patient [Exp(B)=0.367, P=0.003; Exp(B)=0.439, P=0.016, for death and placement, respectively]. Death and placement differ with respect to health service use, race, and group assignment. Whites are more likely to be placed rather than remain at home when compared with African American [Ex(B)=0.520, P=0.028] or Hispanic [Exp(B)=0.338, P<0.005] patients, whereas being assigned to the control condition as opposed to active treatment [Exp(B)=0.515, P=0.008], having a male caregiver [Exp(B)=0.482, P=0.043], and increasing patient health service use [Exp(B)=1.105, P=0.015] are associated with increased mortality. Placed and deceased patients are further differentiated from each other by the fact that caregivers of placed patients report an increase in being bothered by memory problems when compared with caregivers of deceased patients [Exp(B)=0.577, P=0.006]. Patients who are placed, died, or remain at home have unique trajectories, which vary as a function of the reference group used for comparison. Increasing bother with memory problems is uniquely associated with placement relative to death while increasing health service use in the form of physician contacts and nurses visits is uniquely associated with death among community residing Alzheimer disease patients.