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Original Study| Volume 21, ISSUE 8, P1102-1107.e6, August 2020

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

  • Olin Janssen
    Correspondence
    Address correspondence to Olin Janssen, MSc, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
    Affiliations
    Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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  • Stephanie J.B. Vos
    Affiliations
    Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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  • Ron Handels
    Affiliations
    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
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  • Lisa Vermunt
    Affiliations
    Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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  • Robert Verheij
    Affiliations
    Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
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  • Frans R.J. Verhey
    Affiliations
    Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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  • Hein van Hout
    Affiliations
    Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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  • Pieter Jelle Visser
    Affiliations
    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
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  • Karlijn J. Joling
    Affiliations
    Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Published:February 27, 2020DOI:https://doi.org/10.1016/j.jamda.2020.01.008

      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

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