Predictors of nursing home placement in Huntington disease
| Autor: | Vicki Hunt, Joseph Jankovic, Michael R. Swenson, Carol Zimmerman, Lauren Seeberger, Carol Pantello, Kathleen Francis, Jeana Jaglin, Eric Siemers, Kenneth Marck, Oksana Suchowersky, Peter Como, Carmen Polanco, Stephanie Newman, Karen Caplan, Daniel S. Sax, Karl Kieburtz, Ira Shoulson, David Olson, Gina Rohs, Walter J. Koroshetz, J. Beach, Juan Sanchez-Ramos, Kim Lane, Elizabeth Leritz, Donald S. Higgins, Vicki L. Wheelock, Frederick J. Marshall, Tetsuo Ashizawa, W.R. Wayne Martin, Naomi Zubin, Charles A. Adler, Dwight J. Stewart, Samantha Pearce, Marie Saint-Hilaire, Jane B. Lane, Constance Orme, M. Sherr, Richard H. Myers, Marguerite Wieler, Elizabeth McCusker, John Caviness, Jennifer Mazurkiewicz, William Weiner, Kristine Wernette, Steven M. Hersch, Catherine Brown, Merit Cudkowicz, Greg Rudolf, M. Nance, Andrew Feigin, Phillipa Hedges, Adam Rosenblatt, Francis O. Walker, Cindy Lied, Jackie Gray, Elan D. Louis, Jang Ho John Cha, Alexander P. Auchus, Randi Jones, Michael R. Hayden, Kathleen M. Shannon, Hongwei Zhao, Charlyne Hickey, Carol Moskowitz, John B. Penney, Lynn A. Raymond, J. Timothy Greenamyre, Ted M. Dawson, Neal R. Swerdlow, Robert Hauscr, Janet S. Cellar, Elise Kayson, Sandra Russell, Leon S. Dure, Irenita Gardiner, David A. Abwender, Nanette Mercado, Ronald Trent, Audrey Walker, Nancy Pearson, Alicia Facca, Paula Sexton, Mark Guttman, Karen Marder, Teresa Tempkin, Kerry Duncan, Jill Burke-Holder, Gustavo Rey, Anne B. Young, Carson Reider, Roger L. Albin, Jane S. Paulsen, Cindy Hunter, Anders Lundin, Jody Corey-Bloom, Jackie Thomson, Joanne Wojeieszek, Candace Young |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Hallucinations Cross-sectional study Neurological disorder Disease Hypokinesia Severity of Illness Index Rating scale Risk Factors Severity of illness medicine Humans Psychiatry Gait Disorders Neurologic Proportional Hazards Models Proportional hazards model Depression Mental Disorders Chorea Middle Aged medicine.disease Nursing Homes Cross-Sectional Studies Huntington Disease Gait abnormality Female Neurology (clinical) medicine.symptom Psychology |
| Zdroj: | Neurology. 60(6) |
| ISSN: | 1526-632X |
| Popis: | To determine whether motor, behavioral, or psychiatric symptoms in Huntington disease (HD) predict skilled nursing facility (SNF) placement.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 chi2 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.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, p0.0001); were more likely to have obsessions, compulsions, delusions, and auditory hallucinations; and had more aggressive, disruptive (p0.0001), 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.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. |
| Databáze: | OpenAIRE |
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