Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 4;15(12):e0243513.
doi: 10.1371/journal.pone.0243513. eCollection 2020.

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

Marit Mjørud  1   2 , Geir Selbæk  1   2   3 , Espen Bjertness  4 , Trine Holt Edwin  1   2   5 , Knut Engedal  1   2 , Anne-Brita Knapskog  2 , Bjørn Heine Strand  1   2   6
Affiliations

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

Marit Mjørud et al. PLoS One. .

Abstract

Objectives: To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times.

Design: Markov multistate survival analysis and flexible parametric models.

Setting: Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants' address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data.

Participants: 2,938 home-dwelling persons with dementia, ages 40-97 years at time of diagnosis (mean 76.1, SD 8.5).

Results: During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group.

Conclusion: Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Illness-death model for nursing-home admission.
Each transition is a survival model, and the stage the person is in impacts the probability of where to go next.
Fig 2
Fig 2. Probability of being either a home-dweller, nursing-home resident or deceased during a 10-year follow-up after dementia diagnosis.
Unadjusted analysis, N = 2938. The shaded area is a 95% confidence interval.
Fig 3
Fig 3. Survival in nursing home by sex.
N = 992, estimated in flexible parametric models.
See this image and copyright information in PMC

References

    1. Strand BH, Knapskog AB, Persson K, Edwin TH, Amland R, Mjorud M, et al. Survival and years of life lost in various aetiologies of dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) in Norway. PLoS One. 2018;13(9):e0204436 10.1371/journal.pone.0204436 - DOI - PMC - PubMed
    1. Garcia-Ptacek S, Farahmand B, Kareholt I, Religa D, Cuadrado ML, Eriksdotter M. Mortality risk after dementia diagnosis by dementia type and underlying factors: a cohort of 15,209 patients based on the Swedish Dementia Registry J Alzheimers Dis. 2014;41(2):467–77. 10.3233/JAD-131856 - DOI - PubMed
    1. Todd S, Barr S, Roberts M, Passmore AP. Survival in dementia and predictors of mortality: a review. Int J Geriatr Psychiatry. 2013;28(11):1109–24. 10.1002/gps.3946 - DOI - PubMed
    1. McMichael AJ, Zafeiridi E, Passmore P, Cunningham EL, McGuinness B. Factors associated with mortality including nursing home transitions: A retrospective analysis of 25,418 people prescribed anti-dementia drugs in Northern Ireland. J Alzheimers Dis. 2020;73(3):1233–42. 10.3233/JAD-190751 - DOI - PMC - PubMed
    1. Aspell N, O'Sullivan M, O'Shea E, Irving K, Duffy C, Gorman R, et al. Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland. Int J Geriatr Psychiatry. 2019;34(7):999–1007. 10.1002/gps.5101 - DOI - PMC - PubMed

Publication types