Journal article
Predictors of nursing home placement in Huntington disease
Neurology, Vol.60(6), pp.998-1001
03/25/2003
DOI: 10.1212/01.WNL.0000052992.58107.67
PMID: 12654967
Abstract
Objective: To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement.
Methods: Subjects were participants in the Huntington Study Group’s Unified Huntington Disease Rating Scale Database (Rochester, NY) between January 1994 and September 1999. Specific motor, psychiatric, and behavioral variables in subjects residing at home and in SNF were analyzed using χ2 and Student’s t-tests. For a subset of subjects for whom longitudinal data existed, a Cox proportional hazards model controlling for age, sex, and disease duration was used.
Results: Among 4,809 subjects enrolled, 3,070 had clinically definite HD. Of these, 228 (7.4%) resided in SNF. The SNF residents’ average age was 52 years, average disease duration was 8.6 years, and they were predominantly women (63%). The SNF residents had worse motor function (chorea, bradykinesia, gait abnormality, and imbalance, p < 0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p < 0.0001), and irritable behaviors (p = 0.0012). For 1,559 subjects, longitudinal data existed (average length of follow-up, 1.9 years), and 87 (5%) moved from home to SNF. In the Cox model, bradykinesia (HR 1.965, 95% CI 1.083 to 3.564), impaired gait (HR 3.004, 95% CI 1.353 to 6.668), and impaired tandem walking (HR 2.546, 95% CI 1.460 to 4.439) were predictive of SNF placement.
Conclusions: Institutionalized patients with HD are more motorically, psychiatrically, and behaviorally impaired than their counterparts living at home. However, motor variables alone predicted institutionalization. Treatment strategies that delay the progression of motor dysfunction in HD may postpone the need for institutionalization.
Details
- Title: Subtitle
- Predictors of nursing home placement in Huntington disease
- Creators
- V. L Wheelock - University of California, DavisT Tempkin - University of California, DavisK Marder - Columbia UniversityM Nance - University of South FloridaR. H Myers - Boston UniversityH Zhao - University of RochesterE Kayson - University of RochesterC Orme - University of RochesterI Shoulson - University of RochesterHuntington Study Group
- Contributors
- Jane Paulsen (Contributor) - University of Iowa, Psychological and Brain Sciences
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.60(6), pp.998-1001
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1212/01.WNL.0000052992.58107.67
- PMID
- 12654967
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Language
- English
- Date published
- 03/25/2003
- Academic Unit
- Psychiatry; Psychological and Brain Sciences
- Record Identifier
- 9984383282202771
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