Objective: To identify what patient and carer characteristics influence transition into residential care for people with dementia.
Design: Longitudinal study of a cohort of people with dementia and their carers in contact with old age psychiatric services in south London.
Materials and Methods: People diagnosed as having dementia by old age psychiatric services in south-east London and living in the community were recruited along with their main family carer. They were assessed at baseline with a package of instruments including a record of socio-demographic data and measurement of: carer burden, carer mental disorder, carer quality of life, cognitive impairment in the person with dementia, and behavior disturbance in dementia. Subjects were followed up for one year and were assessed at 6 and 12 months to ascertain place of residence.
Results: 100 people with dementia and their main family carer were recruited. At six-month followup 22 were in residential care, 63 in the community, 8 had died and for 7 there were missing data. Between 6 and 12 months, 7 of the 63 in the community went into residential care, 4 died, and 12 were lost to followup. The most striking finding is the twenty-fold protective effect of having a co-resident carer (odds ratio 0.05, 95% confidence interval 0.01 to 0.42, p=0.006). Higher ratings of behavioural problems in the person with dementia were also statistically significantly associated with transition into residential care, as was the psychological domain of quality of life of the carer.
Conclusion: These findings powerfully illustrate the pivotal role carried out by carers of people with dementia; interventions directly targeted at helping them to maintain this role would be supported by these data. These data also suggest that strategies directed at improving carer quality of life and at the resolution of behavioral disorder in the person with dementia may also have particular value.
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