Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-11T04:52:03.020Z Has data issue: false hasContentIssue false
  • English
  • Français

Survival in patients with incident dementia compared with a control group: a five-year follow-up

Published online by Cambridge University Press:  30 March 2012

Daniela Koller ,
Hanna Kaduszkiewicz ,
Hendrik van den Bussche ,
Marion Eisele ,
Birgitt Wiese ,
Gerd Glaeske  and
Falk Hoffmann
Daniela Koller*
Affiliation:
Division Health Economics, Health Policy and Outcomes Research, Centre for Social Policy Research, University of Bremen, Bremen, Germany
Hanna Kaduszkiewicz
Affiliation:
Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Hendrik van den Bussche
Affiliation:
Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Marion Eisele
Affiliation:
Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Birgitt Wiese
Affiliation:
Centre for Biometry, Medical Informatics and Medical Technology, Institute for Biometry, Hannover Medical School, Hannover, Germany
Gerd Glaeske
Affiliation:
Division Health Economics, Health Policy and Outcomes Research, Centre for Social Policy Research, University of Bremen, Bremen, Germany
Falk Hoffmann
Affiliation:
Division Health Economics, Health Policy and Outcomes Research, Centre for Social Policy Research, University of Bremen, Bremen, Germany
*
Correspondence should be addressed to: Daniela Koller, University of Bremen, ZeS Mary-Somervile-Str. 5, 28359 Bremen, Germany. Phone: +49-421-218-58514; Fax: +49-421-218-58617. Email: dkoller@zes.uni-bremen.de.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Dementia is an important disease in older age. Existing studies on dementia mortality face limitations. For instance, they are based on prevalent, small, or geographically limited samples or do not include controls. We aimed to study survival after the first diagnosis of dementia compared with a control group.

Methods: We analyzed claims data of a German health insurance company, including 1,818 incident dementia cases and 7,235 age- and sex-matched non-dementia controls (53% male; mean age 78.8 years). The follow-up was five years. We assessed survival with the Kaplan–Meier curves and performed Cox proportional hazard regression, also including nursing care dependency and comorbidities.

Results: The cumulative five-year mortality was 53.5% in the dementia cases and 31.1% in the control group (hazard ratio: 2.1). Even after adjusting for comorbidities and nursing care, the mortality risk was 1.5 times higher for patients with incident dementia than for controls. Nursing care dependency showed high influence on mortality, likewise in dementia patients and controls.

Conclusions: Although some factors, such as education or the type and severity of dementia, could not be included in the analyses, our study shows a clear influence of dementia on mortality irrespective of age, sex, care dependency, and comorbidities. The strongest influence on mortality was found for dementia patients with nursing care dependency. Taking into account their mortality of around 70% in care level 1 and up to 80% in care levels 2 and 3, healthcare delivery to these patient groups should strongly consider elements of palliative care focusing on the quality of life.

Keywords

dementiamortalitysurvivalcomorbiditiesnursing care dependencyclaims data
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 9 , September 2012 , pp. 1522 - 1530
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agüero-Torres, H., Fratiglioni, L, Guo, Z., Viitanen, M. and Winblad, B. (1999). Mortality from dementia in advanced age: a 5-year follow-up study of incident dementia cases. Journal of Clinical Epidemiology, 52, 737–743.CrossRefGoogle ScholarPubMed
Andersen, K., Lolk, A., Martinussen, T. and Kragh-Sørensen, P. (2010). Very mild to severe dementia and mortality: a 14-year follow-up. The Odense study. Dementia and Geriatric Cognitive Disorders, 29, 61–67.CrossRefGoogle ScholarPubMed
Bartholomeyczik, S. and Hunstein, D. (2004). Time distribution of selected care activities in home care in Germany. Journal of Clinical Nursing, 13, 97–104.CrossRefGoogle ScholarPubMed
Dewey, M. E. and Saz, P. (2001). Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. International Journal of Geriatric Psychiatry, 16, 751–761.CrossRefGoogle ScholarPubMed
Eisele, M. et al. (2010). Utilization patterns of ambulatory medical care before and after the diagnosis of dementia in Germany: results of a case-control study. Dementia and Geriatric Cognitive Disorders, 29, 475–483.CrossRefGoogle ScholarPubMed
Elixhauser, A., Steiner, C., Harris, D. R. and Coffey, R. M. (1998). Comorbidity measures for use with administrative data. Medical Care, 36, 8–27.CrossRefGoogle ScholarPubMed
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Fitzpatrick, A. L., Kuller, L. H., Lopez, O. L., Kawas, C. H. and Jagust, W. (2005). Survival following dementia onset: Alzheimer's disease and vascular dementia. Journal of the Neurological Sciences, 229–230, 43–49.CrossRefGoogle Scholar
Guehne, U., Matschinger, H., Angermeyer, M. and Riedel-Heller, S. (2006). Incident dementia cases and mortality: results of the Leipzig Longitudinal Study of the Aged (LEILA75+). Dementia and Geriatric Cognitive Disorders, 22, 185–193.CrossRefGoogle Scholar
Guehne, U., Riedel-Heller, S. and Angermeyer, M. (2005). Mortality in dementia. Neuroepidemiology, 25, 153–162.CrossRefGoogle ScholarPubMed
Helmer, C., Joly, P., Letenneur, L., Commenges, D. and Dartigues, J. F. (2001). Mortality with dementia: results from a French prospective community-based cohort. American Journal of Epidemiology, 154, 642–648.CrossRefGoogle ScholarPubMed
Koedam, E. L. et al. (2008). Early-onset dementia is associated with higher mortality. Dementia and Geriatric Cognitive Disorders, 26, 147–152.CrossRefGoogle ScholarPubMed
Koller, D. et al. (2010). Ambulatory health service utilization in patients with dementia. Is there an urban-rural difference? International Journal of Health Geographics, 9, 59.CrossRefGoogle ScholarPubMed
Larson, E. B. et al. (2004). Survival after initial diagnosis of Alzheimer disease. Annals of Internal Medicine, 140, 501–509.CrossRefGoogle ScholarPubMed
Mitchell, A. J., Meader, N. and Pentzek, M. (2011). Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy. Acta Psychiatrica Scandinavica, 124, 165–183.CrossRefGoogle ScholarPubMed
Noale, M. et al. (2003). Dementia and disability: impact on mortality. The Italian Longitudinal Study on Aging. Dementia and Geriatric Cognitive Disorders, 16, 7–14.CrossRefGoogle ScholarPubMed
Quail, J. M., Lix, L. M., Osman, B. A. and Teare, G. F. (2011). Comparing comorbidity measures for predicting mortality and hospitalization in three population-based cohorts. BMC Health Services Research, 11, 146.CrossRefGoogle ScholarPubMed
Quan, H. et al. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care, 43, 1130–1139.CrossRefGoogle ScholarPubMed
Riedel-Heller, S., Busse, A. and Angermeyer, M. (2000). Are cognitively impaired individuals adequately represented in community surveys? Recruitment challenges and strategies to facilitate participation in community surveys of older adults: a review. European Journal of Epidemiology, 16, 827–835.CrossRefGoogle ScholarPubMed
Rothgang, H. (2010). Social insurance for long-term care: an evaluation of the German model. Social Policy & Administration, 44, 436–460.CrossRefGoogle Scholar
Schäufele, M., Bickel, H. and Weyerer, S. (1999). Predictors of mortality among demented elderly in primary care. International Journal of Geriatric Psychiatry, 14, 946–956.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Sinforiani, E. et al. (2010). Impact of gender differences on the outcome of Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 30, 147–154.CrossRefGoogle ScholarPubMed
Statistisches Bundesamt (2006). Bevölkerung Deutschlands bis 2050. Wiesbaden, Germany: Federal Statistical Office.Google Scholar
van den Bussche, et al. (2011). Specialist involvement and referral patterns in ambulatory medical care for patients with dementia in Germany: results of a claims data-based case-control study. BMC Health Services Research, 11, 148.CrossRefGoogle ScholarPubMed
van Hout, H., Vernooij-Dassen, M., Bakker, K., Blolm, M. and Grol, R. (2000). General practitioners on dementia: tasks, practices and obstacles. Patient Education and Counseling, 39, 219–225.CrossRefGoogle ScholarPubMed
Waring, S. C., Doody, R. S., Pavlik, V. N., Massman, P. J. and Chan, W. (2005). Survival among patients with dementia from a large multi-ethnic population. Alzheimer Disease and Associated Disorders, 19, 178–183.CrossRefGoogle ScholarPubMed
Wolfson, C. et al. (2001). A re-evaluation of the duration of survival after the onset of dementia. New England Journal of Medicine, 344, 1111–1116.CrossRefGoogle Scholar
Xie, J., Brayne, C. and Matthews, F. E. (2008). Survival times in people with dementia: analysis from a population-based cohort study with 14-year follow-up. BMJ (Clinical Research Ed.), 336, 258–262.CrossRefGoogle Scholar