The need to institutionalize a patient with dementia or Alzheimer's disease depends on the severity of disease and the level of resources for coping with the patient.

Factors associated with reduced need for institutionalization:

(1) caregiver training and counseling

(2) participation in a drug trial (I wonder if this reflects the effects of inclusion and exclusion criteria for a study. Alternatively a person enrolled in a trial may have better social support.)


Factors associated with an increased need for institutionalization - disease severity:

(1) increased dementia severity and duration

(2) inability to walk

(3) extrapyramidal signs

(4) psychotic symptoms, especially delusions

(5) incontinence of stool and/or urine

(6) inability to speak coherently

(7) loss of activities of daily living, especially bathing and grooming

(8) aggression, agitation, and irritability

(9) wandering

(10) nocturnal behavioral disturbance


Factors associated with an increased need for institutionalization - resource related:

(11) poor social support system

(12) unmarried status (particularly for men)

(13) poor health in caregiver

(14) excessive stress for caregiver

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