Time to nursing home admission and death in people with dementia: systematic review and meta-analysis

Abstract

Objective: To summarise available evidence on time to nursing home admission and death among people with dementia, and to explore prognostic indicators.

Design: Systematic review and meta-analysis.

Data sources: Medline, Embase, Web of Science, Cochrane, and Google Scholar from inception to 4 July 2024.

Eligibility criteria for selecting studies: Longitudinal studies on survival or nursing home admission in people with dementia. Studies with fewer than 150 participants, recruitment during acute hospital admission, or less than one year of follow-up were excluded.

Results: 19 307 articles were identified and 261 eligible studies included. 235 reported on survival among 5 553 960 participants and 79 reported on nursing home admission among 352 990 participants. Median survival from diagnosis appeared to be strongly dependent on age, ranging from 8.9 years at mean age 60 for women to 2.2 years at mean age 85 for men. Women overall had shorter survival than men (mean difference 4.1 years (95% confidence interval 2.1 to 6.1)), which was attributable to later age at diagnosis in women. Median survival was 1.2 to 1.4 years longer in Asia than in the US and Europe, and 1.4 years longer for Alzheimer's disease compared with other types of dementia. Compared with studies before 2000, survival was longer in contemporary clinic based studies (P_trend=0.02), but not in community based studies. Taken together, variation in reported clinical characteristics and study methodology explained 51% of heterogeneity in survival. Median time to nursing home admission was 3.3 years (interquartile range 1.9 to 4.0). 13% of people were admitted in the first year after diagnosis, increasing to 57% at five years, but few studies appropriately accounted for competing mortality risk when assessing admission rates.

Conclusions: The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women. About one third of remaining life expectancy was lived in nursing homes, with more than half of people moving to a nursing home within five years after a dementia diagnosis. Prognosis after a dementia diagnosis is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning.

Systematic review registration: PROSPERO CRD42022341507.

Fig 1

Bubble plots of median survival according to age at dementia diagnosis, stratified by time of inclusion and study setting, and of median time to nursing home admission, according to age at diagnosis

Fig 2

Boxplots of yearly probabilities for survival and nursing home admission, with boxes indicating 25th to 75th centiles (IQR) and whiskers depicting 1.5 times the interquartile range (capped off at most extreme observations within this range)

Fig 3

Median survival by type of dementia