Dementia Characteristics Differ Based on Living Situation

Krista Harrison, PhD

Dementia patients are betting off living in residential care or at a nursing home than at home, according to a new study.

In a retrospective cohort study conducted by investigators from the University of California San Francisco, pooled together data from the National Health and Aging Trends Study to examine whether moderately severe dementia patients differ in social, functional, and medical characteristics based on whether they are living at home, in a residential care setting, or at a nursing home facility.

The investigators identified social characteristics for the study participants, including age, sex, race/ethnicity, country of origin, income, educational attainment, partnership status, and household size.

They also measured functional characteristics, including how much help they need with daily activities, falls, mobility device use, and limitation to home or bed, as well as medical characteristics including comorbid conditions, self-rated healthy, hospital stay, symptoms, and dementia behaviors.

Lead author Krista L. Harrison, PhD, of the University of California San Francisco, said in an interview with MD Magazine® patients living at home largely required more medical attention than those living in either a nursing facility or in residential care.

“In some ways, you would think people who had more medical needs might end up moving to facilities with additional medical support,” Harrison said. “On the other hand, residential care and nursing facilities are incredibly expensive, so buying additional medical support is tricky.”

Harrison’s team found that older adults living at home were 2-5 times more likely to be members of a disadvantaged population and had more medical needs than the patients either living in a nursing home facility or residential care.

“Unsurprisingly, the people who live in residential care and nursing facilities tend to have less social support and the people who live at home have more social support,” Harrison said. “The people who lived at home were more likely to be members of historically disadvantaged or vulnerable populations, so they were more likely to be members of racial or ethnic minority groups, more likely to be born outside the US.”

Between 2012-2016 an estimated 3.3 million adults developed incident moderately severe dementia.

In a 5-year period, 2.1 million people were living at home with incident moderately severe dementia with a higher prevalence of demographic characteristics associated with systematic patterns of disadvantage, more social support, less functional impairment, worse health, and more symptoms than those living in residential care or nursing facilities.

In the cohort study, 64% of the 728 patients live at home, 19% are in residential care, and 17% are living in a nursing home facility.

Of the patients living at home, 71% reported bothersome pain, compared to 60% of patients in residential care and 59% living in nursing home.

“In a lot of domains, the people who live in residential care and nursing facilities look more similar to one another than they do to people living at home,” Harrison said. “That makes sense because often the reason people move to more supportive settings is because there aren’t people who are able to look after them in their homes that can meet those needs.”

Harrison explained the next steps for her team, with the long-term goal of enacting policy change.

“The next thing we are working on is exploring more in this population of people living at home, how do these factors relate to understanding time until death,” Harrison said. “Many times, people’s decisions for how long to stay at home, where to receive care is related to their expectation of how long they will likely be contained in this condition or how long the disease course might be.”

The study, “Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia,” was published online in the Journal of the American Geriatrics Society.