Family caregivers of elderly relatives with dementia. Factors that affect the decision to institutionalize: A comparison of two groups

Kitty Muldoon Steel, Fordham University


The decision to institutionalize an elder relative with dementia is influenced by a variety of factors including the elder's behavior, the caregiver's burden, and the current and past relationship with the elder. A cross-sectional study of primary caregivers of elders with dementia was conducted. A self-administered questionnaire was sent to two volunteer samples: (1) caregivers of elders recently placed in a nursing home (N = 104); and (2) caregivers of elders living in the community recruited through a church newspaper (N = 70) and caregivers from a long-term home health care program (LTHHCP) (N = 28). The sample was predominantly female (85%), daughters (60%) and white (92%). The study examined how placement decision was influenced by four independent variables: Behavior Problems, Perceived Burden, Quality of Relationship (stress) and Prior Affective Relations. Two hierarchical logistic regression models were used to estimate odds of placement for independent variables while controlling for antecedent variables (i.e., socioeconomic status, caregiving tasks and duration of caregiving, co-residence with elder, and sudden change in health) and intervening variables (i.e., amount of homecare services). Analyses were first conducted comparing the reduced community sample (n = 70 with 28 LTHHCP removed) with the nursing home sample (n = 104); then the combined community sample (n = 98). An increased risk of institutionalization was associated with (1) a higher score on Behavior Problems Scale, but only for low social position (interaction, p $<$.01), and only for caregivers reporting a higher score on Quality of Relationship Scale (interaction, p $<$.05); (2) a higher score on Perceived Burden Scale (OR = 1.29, p $<$.01); (3) a sudden recent change in elder's health (OR = 22.38, p $<$.01); (4) receiving homecare (OR = 31.55, 24 hour care vs. no care, p $<$.05); and (5) a lower score on Prior Affective Relations Scale (less close) (OR =.57, p $<$.01). Analyses that included the LTHHCP clients with the reduced community sample obscured important relationships. Use of services for LTHHCP was protective, but homecare received by the reduced community sample put them at risk of placement (OR = 3.16). Future research is needed to further delineate subgroups at especially high risk.

Subject Area

Gerontology|Social work|Families & family life|Personal relationships|Sociology

Recommended Citation

Steel, Kitty Muldoon, "Family caregivers of elderly relatives with dementia. Factors that affect the decision to institutionalize: A comparison of two groups" (1996). ETD Collection for Fordham University. AAI9705497.