Longitudinal Predictors of Institutionalization in Old Age

by André Hajek, Christian Brettschneider, Carolin Lange, Tina Posselt, Birgitt Wiese, Susanne Steinmann, Siegfried Weyerer, Jochen Werle, Michael Pentzek, Angela Fuchs, Janine Stein, Tobias Luck, Horst Bickel, Edelgard Mösch, Michael Wagner, Frank Jessen, Wolfgang Maier, Martin Scherer, Steffi G. Riedel-Heller, Hans-Helmut König, AgeCoDe Study Group

Objective

To investigate time-dependent predictors of institutionalization in old age using a longitudinal approach.

Methods

In a representative survey of the German general population aged 75 years and older predictors of institutionalization were observed every 1.5 years over six waves. Conditional fixed-effects logistic regressions (with 201 individuals and 960 observations) were performed to estimate the effects of marital status, depression, dementia, and physical impairments (mobility, hearing and visual impairments) on the risk of admission to old-age home or nursing home. By exploiting the longitudinal data structure using panel econometric models, we were able to control for unobserved heterogeneity such as genetic predisposition and personality traits.

Results

The probability of institutionalization increased significantly with occurrence of widowhood, depression, dementia, as well as walking and hearing impairments. In particular, the occurrence of widowhood (OR = 78.3), dementia (OR = 154.1) and substantial mobility impairment (OR = 36.7) were strongly associated with institutionalization.

Conclusion

Findings underline the strong influence of loss of spouse as well as dementia on institutionalization. This is relevant as the number of old people (a) living alone and (b) suffering from dementia is expected to increase rapidly in the next decades. Consequently, it is supposed that the demand for institutionalization among the elderly will increase considerably. Practitioners as well as policy makers should be aware of these upcoming challenges.

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