There's No Place Like Home - To Die

Dementia patients are more likely to die at home

(RxWiki News) Movie images of families visiting their aging, senile relatives in nursing homes doesn't quite reflect reality. In fact, those with dementia are more often than not at home.

A recent study has found that those who have dementia are more likely to die while living at home as opposed to living in a nursing home.

"Plan now for your twilight years."

Lead author Christopher Callahan, MD, a professor in aging research at the Indiana University School of Medicine and director of the Indiana University Center for Aging Research, and colleagues had expected that most people with dementia move from home to a nursing home.

However, their study found that individuals living with dementia over a longer period of time, such as five or ten years, may zigzag back and forth between home and a nursing facility without any patterns.

Callahan's team looked at the electronic medical records and Medicare and Medicaid claims of 4,197 older adults living in communities from 2001 to 2008. They tracked these seniors for an average of 5 years.

They found that the 1,523 older adults who had some form and level of dementia, unsurprisingly, had a higher number of Medicare and Medicaid claims for use of in a nursing home, in a hospital or for home health.

But these adults also had more transitions of care (such as from home to the hospital) than those without dementia: about 2.6 transitions per person per year compared to 1.4 for those without dementia. They also had an average of 9 to 11 total transitions compared to just 3.8 among those not diagnosed with dementia.

"You probably won't proceed on a straight line from home to hospital to nursing home," Dr. Callahan said. "You will experience multiple transitions as you progress from mild to moderate to advanced dementia."

The majority of people who have been diagnosed with dementia actually die of a different physical condition, such as heart disease, cancer or pneumonia. But this fact appears unrelated to the higher likelihood that they will be home when they die.

Callahan's study found that 74 percent of people diagnosed with dementia will go to a nursing home after they have been in the hospital, and about a quarter of these people will be back in the hospital less than a month later. But the other three quarters will go back home.

A total of 46 percent of those with dementia were home when they died, while 35 percent of those diagnosed with dementia died at the hospital and 19 percent at a nursing facility.

"These results challenge previous assumptions," Dr. Callahan said, noting that the results have implications for everyone related to the care of seniors, whether they are family, professional caregivers, doctors, policymakers or insurance companies. "Caring for people living with dementia requires the attention of our entire health care system."

The study appeared in the May issue of the Journal of the American Geriatrics Society. The research was funded by the National Institute on Aging. The authors had no conflicts of interest.

Review Date: 
May 16, 2012