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A study found many people with dementia live approximately 1 third of their remaining life expectancy in nursing homes.
A new study discovered that, among approximately 300,0000 people with dementia, more than half moved to a nursing home within 5 years after a dementia diagnosis.1 Not only that, but data on approximately 5 million people with dementia revealed that about 1 third of remaining life expectancy was lived in nursing homes.
Nearly 10 million people worldwide receive a dementia diagnosis every year, according to Alzheimer’s Disease International.2 Estimates of dementia survival rates vary across countries: 4 to 8 years according to Alzheimer associations in the US and UK, a median of 3.5 years according to the UK NHS, and 1.5 to 10 years according to Alzheimer associations in other European countries.1
Investigators sought to determine the remaining life expectancy and the amount of time to nursing home admission following a dementia diagnosis, quantifying median times and risks per year. They also aimed to assess how patient characteristics could vary the prognosis.
“This systematic review found that prognosis after a dementia diagnosis is highly dependent on patient, disease, and study characteristics, offering potential for individualized prognostic information and care planning,” wrote investigators, led by Chiara C Brück, a doctoral student at Erasmus MC University Medical Centre in the Netherlands.
The team searched Medline, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar from inception to July 4, 2024, and included 261 longitudinal studies that had ≥ 150 people with dementia who were followed for ≥ 1 year after diagnosis; 235 studies focused on survival (n = 5,553,960) and 79 focused on nursing home admission (n = 352,990). Study samples were from Europe (55%), North America (27%), Asia (13%), Oceania (3%), and South America (1%).
Investigators collected data on age, sex, race/ethnicity, cohabitation status, dementia subtype, pre-baseline disease duration, baseline disease severity, and median time to death or nursing home admission. The median age at the start of the follow-up was 78.8 years (IQR, 75.4 – 82.0), and 63% were female. Most studies assessed all-cause dementia (44%), although some studied Alzheimer Disease (32%), vascular dementia (9%), and Lewy body dementia (5%).
49% of patients were followed from their dementia diagnosis, and 47% already had a dementia diagnosis before the study. The longest follow-up time was 7 years.
Participants had a mean survival of 4.8 years after their dementia diagnosis (IQR, 4.0 – 6.0). Participants with dementia before baseline had a median survival of 3.1 years (IQR, 2.4 – 5.6). The likelihood of survival after receiving a dementia diagnosis ranged from 90% after 1 year to 69% after 3 years, 51% after 5 years, and 21% after 10 years.
Median survival time was shorter with older age (per 10 years increase in age, -1.4 years; 95% confidence interval [CI], -1.0 to -1.8) and was longer in males than females.
The study showed that after a dementia diagnosis, the remaining life expectancy reduced from 6.5 years in men 60 years old to 2.2 in men 85 years old. The remaining life expectancy dropped from 8.9 years in women aged 60 years old to 4.5 years in women 85 years old.
When examining patient characteristics, the analysis showed that every additional year of education was linked to a shorter median survival (0.20 years; 95% CI, -0.38 to -0.03).
“This paradigm postulates that people with higher education are more resilient to brain injury before functional declines,” investigators wrote. “Once this reserve has been used up and dementia is diagnosed, however, these people are already at a more advanced stage of the underlying disease and clinical progression will be faster.”
The time to nursing home admission was significantly shorter in patients who were diagnosed with dementia at an older age (increase in age mean difference, 0.3 years; 95% CI, 0.15 to 0.46). The median time to nursing home admission was 3.3 years (IQR, 1.9 to 4.0); 13% were admitted in the first year of their dementia diagnosis and 57% were admitted after 5 years. Time to nursing home admission did not differ by sex or dementia type, although it tended to be longer in studies conducted outside of Europe or North America (2.1 years; 95% CI, -1.0 to 5.2).
“Future studies on individualized prognosis should ideally include patients at time of diagnosis, accounting for personal factors, social factors, disease stage, and comorbidity, while assessing relevant functional outcome measures above and beyond survival alone,” investigators concluded.
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