Sixty-six outpatients with mild to moderate dementia in Alzheimer's disease at baseline were examined twice with an interval of 12 months. Twenty-two of these patients who were admitted to a nursing home within this period were compared to a group of 44 patients who remained living at home with respect to demographic data, cognitive and physical dysfunction, behavioural changes in daily living and the burden of caregivers. Stepwise discriminant function analysis revealed that older age, global cognitive decline, incontinence, aggression, depression, and the caregiver's wish to leave the care to someone else were predictors for nursing home placement within 1-year follow-up and correctly classified 82% of the cases. The study indicates that factors predicting nursing home placement in Alzheimer patients are complex, including demographic characteristics, level of cognitive and physical functioning, behavioural abnormalities in daily living, as well as burden of the caregiver, and are consistent with predictors of institutionalization found in healthy elderly individuals.
KEY worms-Alzheimer's disease, prognosis, nursing home placement.
Ninety per cent of all Alzheimer patients in Germany are being cared for at home by their families (Sozialdata, 1987). There is general agreement among medical and social services which treat and care for demented persons that autonomy, intimacy and satisfaction of Alzheimer patients can be best preserved when they live in familiar surroundings (Zarit and Zarit, 1982; Katzman, 1987; . This is in accordance with the wish of healthy elderly individuals to remain independent at home and with their conviction that moving or being admitted to a nursing home is a serious loss. For the caregiving relatives, nursing home placement of a demented family member is a crucial decision. It may create a sentiment of relief but also guilt, and may stir up serious conflicts. Nevertheless, in Germany the majority of patients suffering from Alzheimer's disease are submitted to a nursing home at some point in the course of their diseases. However, there are only few studies which have systematically investigated factors associated with an increased risk for institutionalization of Alz-