Report: Dementia diagnosis settings may affect results

Older adults who receive a diagnosis of dementia in a hospital or nursing home have significantly lower survival rates than those diagnosed with these diseases in the community, a new study shows.

The researchers said that receiving a diagnosis during an acute illness, a care transition or at a later stage of the disease is suboptimal, because “this could reflect delayed diagnosis or misdiagnosis and may reflect underlying disparities in access to health”.

The report was published on Tuesday at the Journal of the American Geriatrics Society.

The researchers examined Medicare claims and administrative data from 2012 to 2020 for more than 750,000 people who were initially diagnosed with dementia in 2016 and who were Medicare fee-for-service beneficiaries. The team’s goal was to determine if there was a link between the results and where the disease was diagnosed.

They found that 60.3% of people included in the study received their diagnosis in the community, 17.2% in hospital and 22.5% in a nursing home.

When the team looked at four-year survival rates, they found the rates were 16.1 percentage points lower among those diagnosed in hospitals and 16.8 percentage points lower than those diagnosed in nursing homes. grandparents compared to those receiving diagnosis in the community.

That is, unadjusted survival rates four years after receiving a diagnosis included 50.7% of people in the community versus 30.8% in hospitals and 25.7% in nursing homes.

Interestingly, those diagnosed in the community were more often female, younger, had fewer initial hospitalizations and higher use of home care, and resided in wealthier areas. They were more likely to be Asian or Pacific Islander, Native American or Alaska Native, and Hispanic. Rural beneficiaries were more likely to receive diagnoses in hospitals.

“Structural disparities must be addressed to improve dementia diagnosis, particularly for people in rural areas and communities with greater social deprivation. Improve access to doctors with geriatric expertise in these communities; and “increased dementia training for primary care providers, social workers, nurses and other clinicians working in these areas can help improve the timeliness and accuracy of dementia diagnosis and facilitate referral to appropriate resources,” the authors wrote.