Older adults with newly identified dementia often die, admitted to long-term care within 5 years
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Most community-dwelling older adults with newly identified dementia died or were admitted to a long-term care home within 5 years, according to results of a population-based, retrospective cohort study conducted in Ontario and published in Canadian Medical Association Journal.
“Diagnoses with dementia generally have poor prognosis when it comes to survival and needing to be placed in a nursing home, and these prognoses widely vary based on simple characteristics of the person diagnosed,” Peter Tanuseputro, MD, MHSc, of the Clinical Epidemiology Program at Ottawa Hospital Research Institute, told Healio Psychiatry. “Characteristics include age, sex and whether or not they have a disease that is impacting their organs (ie, heart, kidney or lungs).”
Information on the likely disease trajectory of dementia is important for decisions regarding care, according to the researchers. Prior studies focused on describing the risk factors for death among those living with dementia; however, these studies were limited by their use of specific study cohorts, which restricted their generalizability. Further, the researchers noted that clinicians often do not discuss mortality prognosis following a new dementia diagnosis, which may be explained partly by discomfort regarding discussions of death and a lack of resources to support those discussions.
Tanuseputro and colleagues aimed to describe the association between a new diagnosis of dementia and risk for admission to a long-term care home and death at 5 years. Using linked health administrative databases, they identified community-dwelling individuals aged 65 years or older with a first documented diagnosis of dementia between 2010 and 2012 in Ontario. They determined dementia diagnosis using diagnostic codes from hospital discharges, physician billings, assessment conducted for long-term care and home care, and dispensed cholinesterase inhibitor prescriptions. Five-year risk for death and placement in a long-term care home, adjusted for sociodemographic and clinical factors, served as primary outcome measures. Among 108,757 individuals included in the study cohort, 24.4% remained alive in the community and 20.5% were living in a long-term care home by the end of 5 years. About 55% died, of whom half (27.9%) were admitted to a long-term care home before death. The researchers identified three risk factors associated with increased odds of death:
- being aged 90 years or older (OR = 9.5; 95% CI, 8.8-10.2);
- male sex (OR = 1.7; 95% CI, 1.6-1.7); and
- the presence of organ failure, including chronic obstructive pulmonary disease (OR = 1.7; 95% CI, 1.7-1.8), congestive heart failure (OR = 2; 95% CI, 1.9-2) and renal failure (OR = 1.7; 95% CI, 1.6-1.8).
Further, they observed a 5-year risk for death varying between 22% and 91% for groups formed by combinations of these three factors.
“We were somewhat surprised that only one in four of those diagnosed with dementia was alive and living in the community after 5 years,” Tanuseputro told Healio Psychiatry. “This supports the need to have goals of care discussions early in the disease trajectory, before patients decline, so that people can focus on maximizing the quality of remaining life.”
Tanuseputro and colleagues used study data to develop an online calculator that predicts risk for death and admission to a long-term care facility for patients with dementia.
"We have developed a tool that asks simple questions about a person at the time of dementia diagnosis and translates it to the chance of dying and of entering a nursing home over the next 5 years,” Tanuseputro said in a press release. “This information can be used in conversations about what to expect. For newly diagnosed [patients with dementia] and their families, personalized information about their trajectory may be helpful to plan for the future, including advance care planning and planning for additional supports." – by Joe Gramigna
Reference:
The Centre for Individualized Health. Dementia Survival Tool. https://www.individualizedhealth.ca/dementia-tool. Accessed April 20, 2020.
Disclosures: One study author reports a grant from the Canadian Institutes of Health Research during the conduct of the study. The other authors report no relevant financial disclosures.