(HealthDay News) – Individuals with dementia often live and die at home, and most transitions to a nursing home follow hospitalization, according to a study published in the May issue of the Journal of the American Geriatrics Society.
Christopher M. Callahan, MD, from Indiana University in Indianapolis, and colleagues analyzed the electronic medical records of 4,197 community-dwelling older adults. Medical records were linked to Medicare claims, Medicaid claims, the Minimum Data Set, and the Outcome and Assessment Information Set. Participants were followed for a mean of 5.2 years.
The researchers found that, compared to those never diagnosed with dementia (2,674 individuals), older adults with prevalent (524) or incident (999) dementia had significantly greater use of Medicare (11.4% vs. 44.7% and 44.8%, respectively) and Medicaid (1.4% versus 21% and 16.8%, respectively) nursing facility use; greater hospital (51.2% vs. 76.2% and 86%, respectively) and home health (27.3% vs. 55.7% and 65.2%, respectively) use; and more mean total transitions (3.8 vs. 11.2 and 9.2, respectively). For participants with dementia, most transitions to nursing facilities were transfers from hospitals (74.5%). At time of death, 46% of participants with dementia were at home, 35% were in the hospital, and 19% were in a nursing facility.
“In conclusion, care management programs for older adults with dementia will increasingly need to manage patients in the home, hospital, and nursing facility and to assist with coordination of care and goals of care across these sites and over time,” the authors write.