Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports from 8 European Countries

B. Afram*, A. Stephan, H. Verbeek, M.H.C. Bleijlevens, R. Suhonen, C. Sutcliffe, K. Raamat, E. Cabrera, M.E. Soto, I.R. Halberg, G. Meyer, the RightTimePlaceCare Consortium, J.P.H. Hamers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: To explore reasons for institutionalization of people with dementia according to informal caregivers as well as variation in reasons between countries.

Design: An explorative cross-sectional study was conducted in 8 European countries.

Setting: Per country, a minimum of 3 long term care facilities, offering care and accommodation as a package, participated in this study. Participating countries were selected to represent different geographic areas in Europe.

Participants: Of the 791 informal caregivers involved in the RightTimePlaceCare project of people with dementia who were recently admitted to a long term care facility, 786 were included for this study.

Measurements: As part of a semistructured interview, informal caregivers were asked the main reason for institutionalization in an open-ended question. Answers were categorized according to a conventional coding approach. All reasons were then quantified and tested.

Results: Mainly patient-related reasons were stated, such as neuropsychiatric symptoms (25%), care dependency (24%), and cognition (19%). Neuropsychiatric symptoms were among the most often mentioned reasons in most countries. Besides patient-related reasons, caregiver burden and the inability of the informal caregiver to care for the patient were stated as reasons (both 15%). Further analyses showed countries differ significantly in reasons according to informal caregivers. Additionally, reasons were analyzed for spouses and child-caregivers, showing that spouses more often stated reasons related to themselves compared with child-caregivers.

Conclusion: Multiple reasons contribute to the institutionalization for people with dementia, with several factors that may influence why there were country differences. Variation in the organization of dementia care and cultural aspects, or the relationship between the informal caregiver and person with dementia may be factors influencing the reasons. Because of a wide variation in reasons between countries, no one-size-fits-all approach can be offered to guide informal caregivers when facing the possibility of institutionalization of the person with dementia. 

Original languageEnglish
Pages (from-to)108-116
Number of pages9
JournalJournal of the American Medical Directors Association
Issue number2
Publication statusPublished - Feb 2014


  • Dementia
  • informal caregivers
  • family caregivers
  • reasons for institutionalization
  • CARE

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