Family Practice Vol. 18, No. 1, 39-41
© Oxford University Press 2001
Research in Practice |
Revealing regional differences in the institutionalization of adult patients in homes for the elderly and nursing homes: results of the Belgian network of sentinel GPs
Scientific Institute of Public Health, J Wytsmanstraat 14 1050 Brussels and
a Academic Centre for General Practice, University of Leuven, Leuven, Belgium.
Devroey D, Van Casteren V and De Lepeleire J. Revealing regional differences in the institutionalization of adult patients in homes for the elderly and nursing homes: results of the Belgian network of sentinel GPs. Family Practice 2001; 18: 39–41.
Received 17 February 2000; Revised 22 June 2000; Accepted 5 September 2000.
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Abstract |
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Objectives. The aim of this study was, firstly, to determine the number of institutionalizations in homes for the elderly and nursing homes and, secondly, to learn about regional differences in the placement procedure and the pre-existing problems and diseases.
Methods. Data were recorded during 1994 by the 143 GPs of the network of sentinel practices, which is representative of Belgian GPs. All placements of adult patients in homes for the elderly and nursing homes were registered.
Results. During 1994, Belgian sentinel GPs placed 297 patients in a nursing home or a home for the elderly. Most of them were women and patients who lived alone. At the time of institutionalization, motor function impairment and dementia were the most common diseases. The institutionalizations were motivated mostly by a need for assistance with daily living activities and nursing assistance. An interim hospitalization was necessary in 60% of all institutionalizations. Two-thirds of all patients were on a waiting list. The average length of these waiting lists was shorter in the southern (Walloon) region than in the northern (Flemish) region. Home care services were consulted in 16% of all institutionalizations. In the southern region, home care services were consulted more often than in the northern region.
Conclusions. Motor function impairment and dementia were the most common pre-existing impairments. Placements were often hampered by long waiting lists and interim hospitalization. In the southern region, waiting lists were shorter and home care services consulted more often. Some placements could be avoided or delayed by a better organization and promotion of the possibilities of professional home care services.
Keywords. Elderly, general practice, institutionalization, sentinel surveillance.
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Introduction |
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With the ageing of the population and the changes in social relationships, the number of institutionalizations has risen spectacularly during the last decades. Moreover, placement of a family member often results in guilt and frustration for informal care-givers.1,2
This study compares the results for the northern (Flemish) and southern (Walloon) regions of Belgium concerning the number of placements and the distribution in different types of institutions. Furthermore, data were compared concerning the rational cause of the institutionalization, the pre-existing diseases and the problems that occur during the procedure that precedes the placement.
Important differences could exist between the northern region, which closely resembles northern European countries, and the southern region, which resembles southern European countries.
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Subjects and methods |
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The recordings for this study were made by the Belgian sentinel network of GPs. This network has been functioning since 1979 and serves as a reliable source for the surveillance of morbidity in Belgium.3,4 The data for this study were collected from the 143 sentinel GPs who regularly participated in the registrations during 1994. The registration concerned every adult patient who was institutionalized in a home for the elderly, a nursing home or a psychiatric institution. Because of the low number of placements in psychiatric institutions, these were not taken into account in this study.
The 95% confidence intervals (95% CIs) were calculated on the assumption that the cases followed a Poisson distribution. EpiInfo 6.04® (CDC, Atlanta, Georgia, USA) and SPSS-PC 9® (SPSS Inc., Chicago, Illinois, USA) were used for analysis, statistical processing and detection of significant differences.
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Results |
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Characteristics of the patients
In all, 297 patients (73% women and 27% men) were institutionalized in a home for the elderly or a nursing home. The median age for men (81 years) was not significantly lower than for women (84 years) (Kruskal Wallis P = 0.091). After standardization for age, 46% of men were institutionalized in nursing homes and 54% in homes for the elderly. Women were institutionalized significantly more in homes for the elderly (70%) than in nursing homes (30%) (P = 0.004). There was no significant difference between the southern and the northern region (P > 0.05).
After standardization for age, 52% of both genders lived alone, with or without supervision, and 48% lived together with a partner or family member. Neurological and psychiatric disorders including dementia were the most important pre-existing impairments for both genders. Remarkably, 54% of all women had motor function impairments (36% of men) and 29% of men were short of breath (12% of women).
Of all urgent institutionalizations, 56% were in a home for the elderly and 44% in a nursing home. On the contrary, 68% of the non-urgent placements were in a nursing home and 32% in a home for the elderly. These differences were significant (P = 0.0008).
For both genders, most institutionalizations were motivated by a need for assistance with daily living activities.
Procedure of institutionalization
For more than half of the placements, an interim hospitalization, mostly in an internal medicine ward, was necessary. Two-thirds of the patients were included on a waiting list.
The median duration of the interim hospitalization and the median time on a waiting list were considerably shorter in the southern region than in the northern region (P = 0.007 and P = 0.009) (Figs 1 and 2
). In only 16% of all institutionalizations was any kind of home care (volunteer, medical, nursing and other) consulted before the placement. In the southern region, home care services were involved in 27% of all placements and in the northern region in 12%. In 67% of all institutionalizations, the GP takes care of the patients in the institutions. In the northern region, 37% of the institutionalized patients could not call their own GP. This number was almost half as high in the southern region (22%). It is important to note that in the southern region, external GPs were not allowed in 10% of the placements, compared with 22% in the northern region.
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Discussion |
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It is known, and confirmed by this study, that people living alone are more likely to be subject to institutionalization.5,6 With regard to pre-existing diseases, housing conditions and motivation for institutionalization, no significant differences could be revealed between the regions. Of all institutionalizations, 60% were preceded by an interim hospitalization and two-thirds of the patients were included on a waiting list. Important contrasts exist between the northern and southern regions concerning the waiting lists. These are significantly shorter in the southern region where more placements were preceded by a contact with a home care service. In the northern region, the number of patients placed in institutions where they could not contact their own GP was twice as high as in the southern region. In both regions, >50% of the placements were declared to be of an urgent nature. In these cases, the GP can have an important role to play by evaluating the coping mechanisms and capacities of the informal care-givers and by anticipating need where necessary. However, we must consider the possibility that a lot of requests were declared to be of an urgent nature in order to avoid inclusion on a waiting list.
Conclusion
Regional differences exist concerning the duration of waiting lists and interim hospitalization. These differences show that the number of institutionalizations could be reduced if home care services were better organized and promoted more extensively among GPs and informal care-givers. This should be combined with better training and motivation of informal care-givers. This is confirmed in our study where most of the patients lived alone before the placement, and where nursing problems and a need for assistance with daily living activities motivated most placements.
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Acknowledgments |
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We thank the participating GPs and especially Professor Dr Frank Buntinx (University of Leuven), Dr Wim Aelvoet, Mr Christopher Sykes, Dr Francis Capet and Dr Sophie Quoilin for their constructive contribution to the early version of this paper.
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References |
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1 Greenfield W. Disruption and reintegration: dealing with familial response to nursing home placement. J Gerontol Soc Work 1984; 8: 15–21.
2 Hatch R, Franken ML. Concerns of children with parents in nursing homes. J Gerontol Soc Work 1984; 7: 19–30.
3 Stroobant A, Van Casteren V, Thiers G. Surveillance systems from primary-care data: surveillance through a network of sentinel general practitioners. In Eylenbosch WJ, Noah D (eds). Surveillance in Health and Disease. Oxford: Oxford University Press, 1988: 62–74.
4
Lobet M, Stroobant A, Mertens R et al. Tool of validation of the network of sentinel general practitioners in the Belgian health care system. Int J Epidemiol 1987; 16: 612–618.
5 Montgomery RJV, Kosloski K. A longitudinal analysis of nursing home placement for dependent elders cared for by spouses vs adult children. J Gerontol 1994; 49: 62–74.
6
Bergmann K, Foster EM, Justice AW, Matthews V. Management of demented elderly patients in the community. Br J Psychiatry 1978; 132: 441–449.
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