University of California-San Francisco: Most Seniors With Dementia Live at Home, Despite Pain, Anxiety, Poor Health
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- Shortfall in Home-Based Medical Care for Memory-Impaired Patients Must Be Addressed, UCSF Researchers Say
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Contrary to popular belief, most older Americans with advancing dementia remain in their own homes -- many until they die. But a new study by researchers at UC San Francisco has revealed that this population may endure more pain and have more complex or unaddressed medical needs than their counterparts in nursing homes.
In the study, researchers compared the medical characteristics of 728 adults over 65 with moderately severe dementia, in three settings: the participants' own homes; residential care, which spans the spectrum of retirement communities from those offering support at extra cost to assisted-living facilities; and nursing homes, which care for people unable to attend to their most basic needs.
Although the living-at-home participants had an average age of 82, four years younger than the nursing home residents, the researchers found that they had more chronic conditions -- 3.2 versus 3.1 -- were more likely to be bothered by pain -- 70.8 percent versus 58.6 percent -- and had fallen in the last month or had concerns about falls -- 67.1 percent versus 50.4 percent. Additionally, they were more likely to have anxiety and fair or poor health, rather than good or excellent health.
Seniors Turning Away from Nursing Facilities in Favor of Familiarity of Home
But the authors say the findings -- which appear in the
"Rates of nursing home use are declining because they are expensive and people generally prefer the familiarity of home," said first author
In keeping with the trend away from nursing homes, Medicaid spending on community and home-based services has surpassed spending on institutional care, the authors noted.
The participants were drawn from a sample of Medicare enrollees, representative of seniors nationwide. Some 499 of the total participants lived at home (68.5 percent), 126 lived in residential facilities (17.3 percent) and 103 (14.2 percent) lived in nursing homes. In a 2015 study cited by the authors and drawn from a separate nationally representative sample of
To meet the criteria for moderately severe dementia, the study's participants had a doctor's diagnosis for dementia or were determined to have probable dementia according to a survey algorithm. Additionally, they had to struggle with at least one activity of daily living, such as dressing, bathing or toileting, and a "cognitively-oriented instrumental activity of daily living," such as managing medications or finances.
"At this stage of dementia, patients may have difficulty recalling their address or personal history," said senior author
Seniors in residential facilities with moderately severe dementia differed from those at home and in nursing homes. This group, whose average age was 85, had less depression and anxiety, fewer chronic conditions and less unintentional weight loss. However, the cost of residential care facilities, which average
Seniors in Residential Care More Likely to Be Higher Income, Less Likely to Be Partnered
Not surprisingly, the seniors living in residential care had higher incomes and were more likely to be
Home-based medical care, in which insurance pays for coordinated home care provided by doctors, physician assistants or nurse practitioners and their interdisciplinary teams, is a small but growing portion of health care.
"Some people with dementia who live at home receive home-based primary, geriatric or palliative care, but many more likely do not," said Harrison, who is also affiliated with the
Studies indicate that just 12 percent of homebound people receive primary care in their homes, according to the authors. Such programs result in reductions in disability and depression, fewer visits to emergency departments, fewer hospital stays and long-term care admissions, as well as positive impacts on caregivers' health.
Co-Authors:
Funding: The study was supported by funding from the
Disclosures: The authors report no conflicts of interest.
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