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. 2012;7(9):e46061.
doi: 10.1371/journal.pone.0046061. Epub 2012 Sep 24.

Mild cognitive impairment predicts institutionalization among older men: a population-based cohort study

Danijela Gnjidic  1 , Fiona F Stanaway, Robert Cumming, Louise Waite, Fiona Blyth, Vasi Naganathan, David J Handelsman, David G Le Couteur
Affiliations

Mild cognitive impairment predicts institutionalization among older men: a population-based cohort study

Danijela Gnjidic et al. PLoS One. 2012.

Abstract

Background: There is a lack of evidence on the contribution of mild cognitive impairment (MCI) to institutionalization in older adults. This study aimed to evaluate a range of risk factors including MCI of institutionalization in older men.

Methods: Men aged ≥70 years (n = 1705), participating in the Concord Health and Ageing in Men Project, Sydney, Australia were studied. Participants completed self-reported questionnaires and underwent comprehensive clinical assessments during 2005-2007. Institutionalization was defined as entry into a nursing home facility or hostel at any time over an average of 5 years of follow-up. Cox regression analysis was conducted to generate hazard ratios (HR) with 95% confidence intervals (CI).

Results: A total of 125 (7.3%) participants were institutionalized. Piecewise Cox proportional models were generated and divided at 3.4 years (1250 days) of follow-up due to violation of the proportional hazards assumption for the association between MCI and institutionalization (χ(2) = 6.44, p = 0.01). Dementia, disability in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), poor grip strength, few social interactions, being a Non-English speaking immigrant and age were predictive of institutionalization during both time periods, whereas MCI (HR = 4.39, 95%CI 2.17-8.87) only predicted institutionalization in the period beyond 3.4 years of follow-up. Being married (HR = 0.42, 95%CI: 0.24-0.72) was protective only during the period after 3.4 years of follow-up.

Discussion: In this study, the strongest predictors of institutionalization were dementia, MCI, ADL and IADL disability. MCI was not a predictor of early institutionalization but became a significant predictor beyond 3.4 years of follow-up.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The percentage of participants institutionalized with increasing age.
Test for deviation from linear trend: P = 0.0003.
Figure 2
Figure 2. Kaplan-Meier survival curves of the time until institutionalization by cognitive status groups.
See this image and copyright information in PMC

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