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Incontinence and troublesome behaviors predict institutionalization in dementia
O'Donnell BF, Drachman DA, Barnes HJ, Peterson KE, Swearer JM, Lew RA.. Journal of geriatric psychiatry and neurology, 1992-01-01
Topic: Risk, prevention and care in population studies
Factors predicting the early institutionalization of demented patients were studied in 143 outpatients using univariate and multivariate life-table methods. Four types of factors were evaluated for prognostic value: severity of functional impairment, behavioral disorders, individual patient characteristics, and type of caregiver. After follow-up of 19 +/- 12 months, 51 patients had been institutionalized. Increased global severity of dementia, the presence of troublesome and disruptive behaviors, and incontinence increased the likelihood of institutionalization. The best predictors of institutionalization were paranoia, aggressive behavior, and incontinence. Neither individual patient characteristics (age, education, and gender) nor caregiver relationship to the patient (male spouse, female spouse, and male or female child) influenced institutionalization. Since troublesome behavioral disorders are potentially treatable aspects of dementia leading to institutionalization, their management should be a major focus of therapy in dementia.
Key findings
- After follow-up of 19 +/- 12 months, 51 patients had been institutionalized.
- Increased global severity of dementia, the presence of troublesome and disruptive behaviors, and incontinence increased the likelihood of institutionalization.
- The best predictors of institutionalization were paranoia, aggressive behavior, and incontinence.
- Neither individual patient characteristics (age, education, and gender) nor caregiver relationship to the patient (male spouse, female spouse, and male or female child) influenced institutionalization.
- Since troublesome behavioral disorders are potentially treatable aspects of dementia leading to institutionalization, their management should be a major focus of therapy in dementia.
Why it matters
Among 143 dementia outpatients followed for 19 ± 12 months, 51 moved into an institution; paranoia, aggressive behavior and incontinence were the strongest predictors, and who the caregiver was (spouse or child, male or female) made no difference in this sample. The authors argue that because troublesome behaviors are "potentially treatable," managing them "should be a major focus of therapy in dementia" — but this was an observational study, so it shows these problems predict placement, not that treating them delays it.
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Study details
- Participants51
- Evidence strengthLow
How this study scored 46/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of geriatric psychiatry and neurology) |
| Journal's citation record | 1 / 4 | Journal of Geriatric Psychiatry and Neurology: journal h-index 105 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1992 — older than 20 years, still counted |
| Sample size | 1 / 4 | 51 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 301 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 8.4 citations a year over 36 year(s) since 1992 |
| Impact for its field and year | 3 / 6 | Cited 3.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 12 other studies in this library |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Robert Lew: h-index 76 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Massachusetts Chan Medical School: institution h-index 990 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 1571074) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 46 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
O'Donnell, B. F., Drachman, D. A., Barnes, H. J., Peterson, K. E., Swearer, J. M., & Lew, R. A. (1992). Incontinence and troublesome behaviors predict institutionalization in dementia. Journal of geriatric psychiatry and neurology. https://doi.org/10.1177/002383099200500108
Vancouver
O'Donnell BF, Drachman DA, Barnes HJ, Peterson KE, Swearer JM, Lew RA. Incontinence and troublesome behaviors predict institutionalization in dementia. Journal of geriatric psychiatry and neurology. 1992. doi:10.1177/002383099200500108. PMID: 1571074.
BibTeX
@article{odonnell1992-1571074,
author = {O'Donnell, B. F. and Drachman, D. A. and Barnes, H. J. and Peterson, K. E. and Swearer, J. M. and Lew, R. A.},
title = {{Incontinence and troublesome behaviors predict institutionalization in dementia}},
journal = {Journal of geriatric psychiatry and neurology},
year = {1992},
doi = {10.1177/002383099200500108},
pmid = {1571074},
url = {https://doi.org/10.1177/002383099200500108}
}
Studies this one cites
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Later studies that cite this one
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