Predictors of Institutionalization for People with Multiple Sclerosis

Background: Multiple Sclerosis (MS) is a chronic, progressive disease of the central nervous system.  While the disease course is highly variable, a significant portion of people with MS may spend more than 10 years living with severe disability, and many of those will eventually require full time institutional care.  Despite the high personal and economic costs of this care, little is known about predictors of institutionalization. 

Objectives: Identify predictors of institutionalization amongst persons with multiple sclerosis.

Methods: Longitudinal data from a university MS clinic database were extracted to explore nursing home placement of an urban subgroup.  Cox regression analysis was performed with potential predictors including age of MS onset, sex, as well as measures obtained at the first MS clinic assessment: MS course, Expanded Disability Status Scale score, and disability in specific functional systems. 

Results: Older age of onset and higher baseline scores in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) were significant predictors of nursing home placement. 

Conclusions: Patients with older age of MS onset and those with impairment in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) during their disease course may be at higher risk for future institutionalization.  Further research is needed to confirm these findings and to improve efforts to monitor and minimize the institutionalization of people with MS.