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Nursing home admission for African Americans with Alzheimer's disease
S C Miller1, T R Prohaska, S E Furner
1Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, USA. SusanvMiller@Brown.edu
Background:
For African Americans with Alzheimer's disease (AD), little is known about the time to, and risk factors for, nursing home admission (NHA). Using Consortium To Establish a Registry for Alzheimer's Disease (CERAD) data, this study provides information on NHA for African Americans.
Methods:
This longitudinal study followed subjects (N=122) for as long as 7 years and used survival analysis methodology and variable values at baseline and at follow-up to identify NHA risk factors. Studied were sociodemographic variables, physical symptom and disease status variables, the Blessed Dementia Rating Scale (including subscores), the Clinical Dementia Rating (CDR), and the Mini-Mental State Examination.
Results:
Only 25% of African Americans with AD were estimated to have had a NHA by 3.4 years (confidence interval 2.1, 5.4). Being unmarried resulted in a five times earlier NHA (p< .01), and each unit increase in the CDR resulted in a 74% earlier NHA (p<.01). In the absence of the CDR, limitation in activities of daily living was associated with earlier NHA (p<.05).
Conclusions:
Findings suggest that African Americans with AD spend a substantial time in the community prior to NHA, a longer time than observed in similar studies among whites. This raises public health and clinical concern that African Americans with AD may be residing in the community with substantial unmet needs, and that their caregivers have potentially high levels of burden. The independent associations with time to NHA observed here, although few in number, are consistent with other related research.