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HomeGeriatricsDementia diagnosis and life expectancy – Dutch review

Dementia diagnosis and life expectancy – Dutch review

The average life expectancy of people diagnosed with dementia ranges from nine years at age 60 to 4.5 years at age 85 for women, and from 6.5 to just more than two years, respectively, in men, according to a systematic review of the latest evidence.

The results also suggest that one third of people with dementia are admitted to a nursing home within three years of diagnosis.

Nearly 10m people worldwide receive a diagnosis of dementia every year, but survival estimates vary widely, and few studies have assessed prognosis in terms of time to nursing home admission.

To better understand this, reports News-Medical.net, researchers in The Netherlands set out to determine prognosis for people with a dementia diagnosis, both for remaining life expectancy and for time to nursing home admission.

Their findings are based on 261 studies published between 1984 and 2024 (235 on survival and 79 on nursing home admission) involving more than 5m people with dementia (average age 79, 63% women).

The studies were mainly from Europe and North America with an average follow-up time of seven years.

After assessing study quality, the researchers found that average 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.

Overall, dementia reduced life expectancy by about two years for people with a diagnosis at age 85, three-four years with a diagnosis at age 80, and up to 13 years with a diagnosis at 65.

Average survival was up to 1.4 years longer among Asian populations and 1.4 years longer among people with Alzheimer's disease compared with other types of dementia.

Average time to nursing home admission was just more than three years, with 13% of people admitted in the first year after diagnosis, increasing to a third (35%) at three years and more than half (57%) at five years. However, the authors note that these estimates are less reliable and should be interpreted with caution.

These are observational findings and the authors acknowledge that differences in study methods and inconsistent reporting of measures, such as socioeconomic status, race, disease severity, and pre-existing conditions, may have affected their estimates.

However, they point out that the meticulous search and data extraction enabled analyses of the largest number of studies to date over a prolonged period, “offering potential for individualised prognostic information and care planning”.

They conclude: “Future studies on individualised prognosis should ideally include patients at time of diagnosis, accounting for personal factors, social factors, disease stage, and comorbidity, while assessing relevant functional outcome measures above and beyond survival alone.”

Their findings were published in The BMJ.

In a linked editorial, researchers from Norway say although the understanding of survival with dementia has advanced substantially, the complexities of predicting the timeline for nursing home admission persist.

“To enhance future healthcare services and optimise quality of life for people with dementia and their families, it is crucial that we continue to strive for more precise, context sensitive insights,” they said.

Study details

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

Chiara C Brück, Sanne Mooldijk, Frank J Wolters et al.

Published in The BMJ on 8 January 2025

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 (Ptrend=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.

 

The BMJ article – Time to nursing home admission and death in people with dementia: systematic review and meta-analysis (Open access)

 

The BMJ linked editorial – Dementia, survival rates, and nursing home admissions (Open access)

 

News-Medical.net article – Life expectancy and nursing home admission in people with dementia (Open access)

 

See more from MedicalBrief archives:

 

Four in 10 dementia cases could be prevented or delayed — Lancet Commission

 

Mental health illness toll on life expectancy – South African study

 

Marriage may stave off dementia

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