International Psychogeriatrics

Research Article

Predictors of nursing home admission among Alzheimer's disease patients with psychosis and/or agitation

Edward Alan Millera1 c1, Lon S. Schneidera2 and Robert A. Rosenhecka3

a1 Department of Gerontology and Gerontology Institute, McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, MA, U.S.A.

a2 University of Southern California Keck School of Medicine, Los Angeles, CA, U.S.A.

a3 Yale University School of Medicine and VA New England Mental Illness Research and Education Center, West Haven, CT, U.S.A.


Background: The purpose of this study is to identify factors that predict nursing home placement among community-dwelling Alzheimer's disease (AD) patients with psychosis and/or agitation in a randomized clinical trial ( number, NCT00015548).

Methods: 418 participants with AD enrolled in the Clinical Antipsychotic Trial of Intervention Effectiveness – AD (CATIE-AD) trial of anti-psychotic medications and having no evidence of nursing home use at baseline were followed at 9 months post-random assignment using data provided by caregiver proxy. χ2 tests, t-tests and Cox proportional hazard modeling were used to examine the baseline correlates of nursing home use.

Results: Of outpatients with no prior nursing home use, 15% were placed in a nursing home in the 9 months following baseline, with the average time to placement being 122 days. Bivariate analyses indicate that those with prior outpatient mental health use at study entry were more likely to be admitted; so too were those with worse physical functioning – i.e. lower scores on the AD Cooperative Study Activities of Daily Living Scale (ADCS-ADL), lower utility scores on the Health Utility Index (HUI)-III, and worse cognition on the Mini-mental State Examination. Controlling for other factors, non-Hispanic white race (hazard ratio [HR] = 2.16) and prior mental health use (HR = 1.87) increased the likelihood of admission. Those with higher ADCS-ADL scores were less likely to be placed (HR = 0.97).

Conclusions: Factors leading to nursing home entry among psychotic/agitated AD patients are similar to the general population, though high incidence of nursing home entry highlights the importance of accounting for such utilization in health economic studies of AD outcomes. It also highlights the importance of using information on ADLs and other characteristics to develop profiles identifying those at greater or lesser risk of nursing home entry and, in so doing, inform population planning associated with AD and identification of those patients and caregivers who might benefit most from interventions to prevent eventual placement.

(Received June 22 2009)

(Revised August 18 2009)

(Revised January 25 2010)

(Accepted January 28 2010)

(Online publication March 10 2010)


c1 Correspondence should be addressed to: Edward Alan Miller, Department of Gerontology, John W. McCormack Graduate School of Policy Studies, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, U.S.A. Phone: +1 617-287-7313, Fax: +1 617-287-7080. Email: