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1.  Instrumental Activities of Daily Living (I-ADL) trigger an urgent request for nursing home admission 
Objective
Although disabled elderly people mostly prefer to receive care at home or in other community settings, many of them reside in nursing homes. That is why several researchers have tried to identify predictors of institutionalisation. Various different dependency factors seem to explain the request for residential care. The aim of this study is to discover the most important factor triggering an urgent request for nursing home admission.
Methods
On the basis of social field research, we analysed the profiles and motives of an admission cohort of 125 elderly (31 men and 94 women) who were admitted to four nursing homes in Antwerp (Belgium) between January 2000 and April 2001. The study used data of the 'intake conversation', performed by an experienced social worker of the nursing home, subsequent to the request for nursing home admission.
Gender, age, Katz category, marital status, disease, living conditions, Personal and Instrumental Activities of Daily Living (P-ADL and I-ADL) were the independent variables.
The variable 'time span' was introduced as dependent variable. This is the time between the onset of dependency and the request for institutionalisation. Nursing home carers have classified this time span in three periods: < 3, 3-12, and > 12 months. The statistical analysis focused on the characteristics of the two extremes, namely the earliest versus the latest applicants (n = 74). This was the best strategy to go about investigating the issue due to the vagueness and uncertain status of the data in the midrange.
Results
The applicants had an average age of 83 years. 31% of the elderly were defined as functioning good (needing assistance from another person in no to maximum two ADLs - washing and dressing) and 69% were classified as ill functioning (needing assistance in minimum three ADLs). Women were more likely to be widowed (83%) and to live alone and isolated (55%) and they had a lower degree of dependency (both P-ADL and I-ADL) when entering institutions. Of the women, 57% had a mental illness, compared with 48% of the men. Of the applicants, 34% were unwilling or unable to start home care and applied for an urgent request (within the first 3 months); 41% tried home care for a time and 26% applied after one year of home care.
The stepwise logistic regression analysis identified I-ADL as the decisive factor explaining the difference in 'decision speed' towards institutionalisation. An increase of one unit on the I-ADL score increased the chance of a request within the first three months by 63% (95%CI: 19 to135%, p = 0.006).
Conclusions
The only factor related to an urgent request for nursing home admission seems to be the I-ADL score. These results have important implications for targeting sheltered housing and further extension of home care services to postpone or prevent institutionalisation.
doi:10.1186/0778-7367-70-2
PMCID: PMC3415109  PMID: 22958483
2.  Medical Conditions of Nursing Home Admissions 
BMC Geriatrics  2010;10:46.
Background
As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors have a strong impact on nursing home (NH) admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis) of a nursing home admission with respect to the underlying disease.
Methods
This study is based on two independent, descriptive and comparative studies in Belgium and was conducted at two time points (1993 and 2005) to explore the evolution over twelve years. Data from the subjects were extracted from the resident's file; additional information was requested from the general practitioner, nursing home physician or the head nurse in a face-to-face interview. In 1993 we examined 1332 residents from 19 institutions, and in 2005 691 residents from 7 institutions. The diseases at the time of admission were mapped by means of the International Classification of Diseases - 9th edition (ICD-9). Longitudinal changes were assessed and compared by a chi-square test.
Results
The main chronic medical conditions associated with NH admission were dementia and stroke. Mental disorders represent 48% of all admissions, somatic disorders 43% and social/emotional problems 8%. Of the somatic disorders most frequently are mentioned diseases of the circulatory system (35%) [2/3 sequels of stroke and 1/5 heart failure], followed by diseases of the nervous system (15%) [mainly Parkinson's disease] and the musculoskeletal system (14%) [mainly osteoarthritis]. The most striking evolution from 1993 to 2005 consisted in complicated diabetes mellitus (from 4.3 to 11.4%; p < 0.0001) especially with amputations and blindness. Symptoms (functional limitations without specific disease) like dizziness, impaired vision and frailty are of relevance as an indicator of admission.
Conclusion
Diseases like stroke, diabetes and mobility problems are only important for institutionalisation if they cause functional disability. Diabetes related complications as cause of admission increased almost three-fold between 1993 and 2005.
doi:10.1186/1471-2318-10-46
PMCID: PMC2912913  PMID: 20630079
3.  Where do the elderly die? The impact of nursing home utilisation on the place of death. Observations from a mortality cohort study in Flanders 
BMC Public Health  2006;6:178.
Background
Most of the research concerning place of death focuses on terminally ill patients (cancer patients) while the determinants of place of death of the elderly of the general population are not intensively studied. Studies showed the influence of gender, age, social-economical status and living arrangements on the place of death, but a facet not taken into account so far is the influence of the availability of nursing homes.
Methods
We conducted a survey of deaths, between January 1999 and December 2000 in a small densely populated area in Belgium, with a high availability of nursing homes (within 5 to 10 km of the place of residence of every elderly). We determined the incidence of total mortality (of subjects >60 years) from local official death registers that we consulted via the priest or the mortician of the local parish, to ask where the decedent had died and whether the deceased had lived in a nursing home. We compared the distribution of the places of death between parishes with a nursing home and with parishes without nursing home.
Results
240 women and 217 men died during the two years study period. Only 22% died at home, while the majority (78%) died in an institutional setting, either a hospital (50%) or a nursing home (28%). Place of death was influenced by individual factors (age and gender) and the availability of a nursing home in the 'own' parish. The chance of in-hospital death was 65% higher for men (95% Confidence Interval [CI]: 14 to 138%; p = 0.008) and decreased by 4% (CI: -5.1% to -2.5%; p < 0.0001) for each year increase in age. Independent of gender and age, the chance of in-hospital death was 41% (CI: -60% to -13%; p = 0.008) lower in locations with a nursing home.
Conclusion
Demographic, but especially social-contextual factors determine where elderly will end their life. The majority of elderly in Flanders die in an institution. Age, gender and living situation are predictors of the place of death but the embedment of a nursing home in the local community seems to be a key predictor.
doi:10.1186/1471-2458-6-178
PMCID: PMC1552067  PMID: 16824222

Results 1-3 (3)