Men with Alzheimer's disease typically live at home under the care of their wives. Women with Alzheimer's disease typically move to nursing homes after being cared for by their daughters. A study of nursing home admissions provided interesting revelations about marital commitments versus child-parent care giving commitments.

Rosalie Young, PhD, Wayne State University associate professor of community medicine, studied 573 Alzheimer's patients and their families and found that females with Alzheimer's disease were more likely to be admitted to nursing homes than males. Although the study was age-adjusted to account for the fact that women generally live longer than men, it still showed that 75-80 percent of nursing home residents are women whose family factors-instead of critical health factors-prompted nursing care. The study was published in Women's Health Issues, January-February 2003.

"Our results show that females and males were institutionalized for different reasons," Dr. Young said. "Men were put in nursing homes primarily for medical and care giving need factors-that is, they needed constant medical attention or supervision. Women showed less physical and less cognitive impairment after the nursing home placement, and had received less family support and care before institutionalization. Adult children caring for their chronically ill mothers reported a heavy care giving burden characterized by frustration and stress. But burden is a subjective measure, not a medical measure, making it clear that a family's personal factors play a major role in deciding how to care for somebody with Alzheimer's. "

Dr. Young suggests two reasons for these gender-linked patterns of institutionalization. First, being cared for by a spouse is the strongest deterrent to nursing home admission and few female patients had this advantage. Overall, 70 percent of male Alzheimer's patients received care from their wives, while a similar proportion of females received care from their adult children. "It seems husbands and wives make commitments that do not extend to parent-child relationships," Dr. Young said.

The second reason for the high rate of female admission to nursing homes may involve the mother-daughter relationship. "Interpersonal and power issues may have never been resolved, thus making it easier for a daughter to admit her mother than her father into a nursing home," Dr. Young said. Questions about mother-daughter conflicts were not addressed in this study, but could provide insight in the future.

Previous studies have shown that nursing home admission does not automatically occur when a patient reaches a certain level of deterioration. Furthermore, physicians don't have an exact point at which they recommend nursing care. So, the question of nursing home placement is often a prolonged and difficult decision. Dr. Young hopes new studies about caring for chronically ill patients will put more emphasis on social, psychological and family care factors that have major impact on health, impairment and medical outcomes.

The full published article can be viewed online at Science Direct.

With more than 1,000 medical students, WSU is among the nation's largest medical schools. Together with its clinical partner the Detroit Medical Center, the school is a leader in patient care and medical research in a number of areas, including cancer, genetics, the neurosciences and women's and children's health.