Five-year risk of admission to long-term care home and death for older adults given a new diagnosis of dementia: a population-based retrospective cohort study

Abstract

BACKGROUND: After diagnosis of a health condition, information about sur vival and potential transition from com munity into institutional care can be helpful for patients and care providers. We sought to describe the association between a new diagnosis of dementia and risk of admission to a longterm care home and death at 5 years. METHODS:We conducted a population based retrospective cohort study using linked health administrative databases. We identified individuals aged 65 years or older, living in the community, with a first documented diagnosis of dementia between Jan. 1, 2010, and Dec. 31, 2012, in Ontario, Canada. Dementia diagnosis was captured using diagnostic codes RESULTS: We identified 108 757 individ uals in our study cohort. By the end of 5 years, 24.4% remained alive in the com munity and 20.5% were living in a long term care home. Of the 55.1% who died, about half (27.9%) were admitted to a longterm care home before death. Three risk factors were associated with increased odds of death: older age (age ≥ 90 yr; odds ratio [OR] 9.5, 95% confidence interval [CI] 8.8-10.2 [reference: age 65-69 yr]), male sex (OR 1.7, 95% CI 1.6-1.7), and the pres ence of organ failure, including chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.7-1.8), congestive heart failure (OR 2.0, 95% CI 1.9-2.0) and renal failure (OR 1.7, 95% CI 1.6-1.8). Groups formed by combinations of these 3 factors had an observed 5year risk of death varying between 22% and 91%.

Trends of Dementia among Community-Dwelling Adults in Ontario, Canada, 2010–2015

“…Studies in Norway [30], Korea [31], and Canada [32] estimated the median survival time between 3.3 and 9.1 years, and a German study [33] estimated the mean survival time to be 3.1 years; however, these studies did not report trends in mortality over time. A recent study from Ontario reported that the 5-year mortality for individuals diagnosed with dementia in community settings between 2010 and 2012 was 55.1%, and that 48.4% transitioned to LTC within 5 years [6]. These results are comparable to our study, which ob-served that 42.7% of PLWD transition to LTC, 49.6% die within 5 years, and the median time to LTC admission and death was not realized.…”

“…Restricting Dement Geriatr Cogn Disord 2020;49:286-294 DOI: 10.1159/000508687 our analysis to the community-dwelling population helps policymakers tailor community-based services. The validated dementia ascertainment algorithm used in this study has been implemented in other research related to dementia [6,12,35]. Lastly, by studying multiple objectives we provide a comprehensive picture of communitydwelling PLWD, where results may be generalized to other developed countries.…”

“…Approximately 60% of all people living with dementia (PLWD) reside in community settings, outside of long-term care (LTC) settings or nurs-ing homes [3][4][5]. As dementia results in progressive impairment, people affected by dementia will initially be diagnosed and supported in community settings, although approximately 25% will eventually require long-term nursing home or LTC supports [6][7][8]. Therefore, the majority of dementia care occurs in community settings, with costs being associated with informal care partners (e.g.…”

The effect of comorbidities on survival in persons with Alzheimer’s disease: a matched cohort study

“…In a systematic review and meta-analysis of people with dementia by van de Vorst et al [ 33 ] coronary artery disease and chronic heart failure were associated with mortality. A recent Canadian study of community dwelling people at the time of dementia diagnosis also reported increased risk of death with chronic heart failure, but did not report on other cardiac diseases [ 8 ]. However, A Dutch study restricted to people with AD found no association of history of cardiovascular disease (including stroke) and mortality, [ 7 ] but the lack of association may be due to small sample size.…”

“…However, the findings have often been inconsistent. For example, male gender [ 4 – 8 ], lower education level [ 9 ], and older age at diagnosis [ 4 – 8 , 10 – 12 ] have been associated with higher risk of death in people with dementia, while these associations have not been observed in other studies [ 10 – 14 ].…”