Longitudinal Predictors of Institutionalization in Old Age

PLoS One. 2015 Dec 14;10(12):e0144203. doi: 10.1371/journal.pone.0144203. eCollection 2015.


Objective: To investigate time-dependent predictors of institutionalization in old age using a longitudinal approach.

Methods: In a representative survey of the German general population aged 75 years and older predictors of institutionalization were observed every 1.5 years over six waves. Conditional fixed-effects logistic regressions (with 201 individuals and 960 observations) were performed to estimate the effects of marital status, depression, dementia, and physical impairments (mobility, hearing and visual impairments) on the risk of admission to old-age home or nursing home. By exploiting the longitudinal data structure using panel econometric models, we were able to control for unobserved heterogeneity such as genetic predisposition and personality traits.

Results: The probability of institutionalization increased significantly with occurrence of widowhood, depression, dementia, as well as walking and hearing impairments. In particular, the occurrence of widowhood (OR = 78.3), dementia (OR = 154.1) and substantial mobility impairment (OR = 36.7) were strongly associated with institutionalization.

Conclusion: Findings underline the strong influence of loss of spouse as well as dementia on institutionalization. This is relevant as the number of old people (a) living alone and (b) suffering from dementia is expected to increase rapidly in the next decades. Consequently, it is supposed that the demand for institutionalization among the elderly will increase considerably. Practitioners as well as policy makers should be aware of these upcoming challenges.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Dementia / diagnosis*
  • Dementia / physiopathology
  • Depression / diagnosis*
  • Depression / physiopathology
  • Female
  • Germany
  • Hearing Loss / diagnosis*
  • Hearing Loss / physiopathology
  • Homes for the Aged / statistics & numerical data*
  • Humans
  • Institutionalization / statistics & numerical data*
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Marital Status / statistics & numerical data
  • Mobility Limitation
  • Nursing Homes / statistics & numerical data*
  • Personality Assessment
  • Probability

Grants and funding

This publication is part of the German Research Network on Dementia (KND), the German Research Network on Degenerative Dementia (KNDD), and the Study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) and was funded by the German Federal Ministry of Education and Research (grants KND 01GI0102, 01GI0420, 01GI0422, 01GI0423, 01GI0429, 01GI0431, 01GI0433 and 01GI0434; grants KNDD 01GI0710, 01GI0711, 01GI0712, 01GI0713, 01GI0714, 01GI0715 and 01GI0716; and grants AgeQualiDe 01GY1322A, 01GY1322B, 01GY1322C, 01GY1322D, 01GY1322E, 01GY1322F, 01GY1322G). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.