Deciding about nursing home care in dementia: A conjoint analysis of how older people balance competing goals

Aim: “Don't put me in a home” is a common preference of older people, but so too is “I don't want to be a burden on my family.” These and other goals often conflict with each other when people have worsening dementia and the issue of possible nursing home admission arises. Methods: Community-dwelling older hospital patients were asked to imagine that they lived alone, had dementia and were experiencing increasing practical difficulties, and were presented with 11 possible “outcome packages.” Conjoint analysis was used to investigate how participants ranked possible outcomes and traded-off between these factors: place of residence (home or nursing home), burden on their family, risk of harm and duration of life. Results: Of 122 potential participants, 102 inpatients aged 65–80 years completed the study. Of these participants, 46 (46%) patients give the greatest weight to reducing the burden on their family, 39 (39%) to remaining at home, 11 (11%) to minimizing the risk of harm and five (5%) to maximizing the length of life. There were no significant clinical or demographic differences between these groups. There was a strong negative correlation (Spearman's rho −0.59, P < 0.0001) between importance scores for place of residence and for burden on family. Conclusions: There are important differences in how individual older people would balance the competing priorities of reducing the burden on their family and remaining at home in the event of developing dementia. Geriatr Gerontol Int 2017; 17: 2435–2440.