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Alzheimer's, Dementia & Mental Health
Alzheimer’s Patients Decline Faster after Entering a
Nursing Home
Most educated had most decline; day care experience
lessened decline
 June 1, 2007 – Alzheimer’s disease patients
experienced a more rapid decline in their mental abilities after being
placed in a nursing home, except for those that had prior experience in
adult day care. These patients did not experience this faster rate of
cognitive decline according to a new study by the Rush Alzheimer’s
Disease Center.
The study, published in the June issue of the
American Journal of Psychiatry, finds that prior experience in adult day
care may make the transition to a nursing home less stressful.
The observational study involved 432 older persons
with Alzheimer’s disease who were recruited from health care settings in
the Chicago area. At baseline, they lived in the community and 196
participants were using day care services from 2 to 6 days a week for an
overall mean of 1.7 days a week.
At six month intervals for up to four years, they
completed nine cognitive tests from which a composite measure of global
cognition was derived.
On average, cognition declined at a gradually
increasing rate for all participants. During the study period, 155
persons were placed in a nursing home, and placement was associated with
a lower level of cognition and more rapid cognitive decline.
Study participants who had previous adult day care
experience fared better.
As the level of day care use at the study’s
beginning increased, the association of nursing home placement with
accelerated cognitive decline substantially decreased. Thus, people
using day care 3 to 4 days a week at the beginning of the study showed
no increase in cognitive decline upon nursing home placement.
“The findings suggest that experience in day care
may help individuals with Alzheimer’s disease make the transition from
the community to institutional residence,” said study author Robert S.
Wilson, Ph.D., a neuropsychologist at the Rush Alzheimer’s Disease
Center.
The study also found that a higher level of
education was associated with accelerated cognitive decline upon nursing
home placement.
Yet, day care use markedly reduced the association
of education with accelerated cognitive decline in the nursing home;
further evidence that there is a robust association between day care
experience and cognition during the transition to a nursing home.
The authors considered the possibility that nursing
home placement is simply a sign of increased severity of Alzheimer’s
disease. Yet, the nursing-home-related increase in cognitive decline was
observed even after simultaneous control for cognitive and noncognitive
indicators of dementia severity at the time of nursing home entry.
Alternatively, the increased cognitive decline upon
placement may reflect difficulty adapting to an unfamiliar environment,
consistent with clinical reports of increased confusion and behavior
problems in those with dementia during acute hospitalization or trips
away from home. Patients who had prior adult day care services may have
been better able to adjust to the unfamiliar environment.
“The findings suggest that the transition from the
community to a nursing home is particularly difficult for people with
Alzheimer’s disease and that those planning for their care should
consider the possibility that experience in adult day care programs may
help prepare affected persons for institutional living,” said Wilson.
The research was supported by grants from the
National Institutes on Aging, which leads the federal effort supporting
and conducting research on aging and the medical, social and behavioral
issues of older people, including Alzheimer’s disease and age-related
cognitive decline.
The Rush Alzheimer's Disease Center is one of
approximately 30 NIA-supported Alzheimer's Disease Centers across the
U.S. which conduct basic science, clinical, and social and behavioral
research on dementia and AD. General information on aging and aging
research can be viewed at the NIA's home website,
www.nia.nih.gov.
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