Format

Send to

Choose Destination
J Am Med Dir Assoc. 2020 Feb 26. pii: S1525-8610(20)30033-5. doi: 10.1016/j.jamda.2020.01.008. [Epub ahead of print]

Duration of Care Trajectories in Persons With Dementia Differs According to Demographic and Clinical Characteristics.

Author information

1
Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands. Electronic address: olin.janssen@maastrichtuniversity.nl.
2
Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
3
Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.
4
Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
5
Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
6
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
7
Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden; Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.

Abstract

OBJECTIVES:

To estimate (1) the duration of no formal care, home care, and institutional care after dementia diagnosis, and (2) the effect of age, sex, living situation, dementia medication, migration background, and income on this dementia care duration.

DESIGN:

Longitudinal retrospective study using routinely recorded general practice electronic health records linked with population-based healthcare and mortality data.

SETTING AND PARTICIPANTS:

In total, 11,012 community-dwelling persons who received an incident dementia diagnosis and were listed in a Dutch general practitioner database from 448 general practices in the Netherlands.

METHODS:

Using multistate modeling analyses, we estimated the mean duration of care types (no/home/institutional care) for different ages based on simulations of transition rates and examined the influence of demographic and clinical factors on these durations.

RESULTS:

From dementia diagnosis onward in 85-year-old men, the mean duration without formal care was 0.7 years, of home care 1.7, and institutional care 1.1 years. In 85-year-old women, the duration without formal care was 0.8 years, of home care 2.3, and institutional care 2.3 years. Total care duration was 3.5 years in 85-year-old men and 5.4 years in 85-year-old women. In men, the duration of home care was longer compared with no formal care and institutional care. The duration of no formal care was longer in persons not living alone, without prescribed dementia medication, with a non‒Western migration background, or with a higher income. The duration of home or institutional care was longer in women, persons without polypharmacy, in those living alone, or those with a Western background.

CONCLUSIONS AND IMPLICATIONS:

Our findings help to increase understanding of long-term dementia care trajectories and show that demographic and clinical factors determine the duration of care types. Our results can contribute to the organization of healthcare resource planning and monitoring of the effects of healthcare policy and interventions.

KEYWORDS:

Dementia; home care; institutional care

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center