The process of definitive institutionalization of community dwelling demented vs non demented elderly: data obtained from a network of sentinel general practitioners Birgitte Schoenmakers 1 * , Frank Buntinx 1 , Dirk Devroey 2 , Viviane Van Casteren 2 and Jan DeLepeleire 1 1 Catholic University Leuven, Academic Centre of General Practice, Leuven, Belgium 2 Unit of Epidemiology, Scientific Institute of Public Health, Brussels SUMMARY Objective The aim of the present study was to investigate the differences between characteristics of community dwelling demented and non demented elderly and their caregivers at the moment of definitive institutionalization. Methods The study is a cross-sectional analysis performed on data obtained from a Network of Sentinel General Practitioners. Results Older demented patients with several concomitant diseases were mainly placed because of unmanageable behavioral disturbances. Strikingly, these dementia patients were more often confronted with a time delay in definitive institutionalization due to their high care dependence. Although burden in the dementia family caregivers was an important motivation for definitive institutionalization, it did not seem to be a motive in the final institutionalization circumstances. Conclusions Behavioral disturbances are independently of caregiver burden, professional support, or a spousal relation- ship the main direct reason for institutionalization of community dwelling demented elderly. The way caregivers feel supported might play the key role in the final placement decision. Copyright # 2008 John Wiley & Sons, Ltd. key words — dementia; institutionalization; family caregiver INTRODUCTION Providing care to a community dwelling demented elderly puts a high burden on the involved family members. Being confronted with the high workload, the social isolation and the tremendous changes in family role patterns, over 60% of all caregivers consider at least once definitive institutionalization (Colerick and George, 1986; Lieberman and Kramer, 1991). Together with the reality of growing numbers care needing demented elderly, the number of institutionalizations progressively increases (Hebert et al., 2001; Thomas et al., 2004). Beside, dementia is known as an independent risk factor for definitive institutionalization (Scott et al., 1997; Aguero-Torres et al., 2001; Andel et al., 2007). In general, median time from dementia diagnosis to definitive institutionalization is three to four years (Hebert et al., 2001). The decision process of an definitive institutionalization is the result of a complex interaction between caregiver and patient related factors (Yaffe et al., 2002). Since the early 1990s, several studies have reported on the relation between overloaded and depressed caregivers and definitive institutionalization of the demented (Colerick and George, 1986; Lieberman and Kramer, 1991; Schulz et al., 2004). A certain placement risk-profile of community demented elderly can be proposed (Ferrario et al., 2003). Highly care dependent relatives, performing disruptive behavior and being cared for by a burdened, depressed, spousal caregiver are more likely to be institutionalized (Mittelman et al., 1996). INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry (2008) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.2147 *Correspondence to: Dr B. Schoenmakers, Kapucijnenvoer 33 blok J- box 7001, 3000 Leuven, Belgium. E-mail: birgitte.schoenmakers@med.kuleuven.be Copyright # 2008 John Wiley & Sons, Ltd. Received 31 January 2008 Accepted 8 September 2008