Low socioeconomic status (SES) has been linked to a higher incidence of dementia. Less is known about the association between SES and mortality in persons with dementia. We studied this association in a prospective cohort of 15,558 patients in the Netherlands between 2000 and 2010. SES was measured using disposable household income and divided in tertiles. Overall, there was a negative relationship between SES and mortality in both sexes and both settings of care. For men who visited a day clinic, the 5-year mortality rate was 74% among those in the lowest tertile of SES and 57% among those in the highest; for women, the rates were 60% and 50%, respectively. The differences in median survival times between persons in the lower and upper tertiles of SES were 260 days for men and 300 days for women. For men who were admitted to the hospital, the 5-year mortality rate was 89% among those in the lowest tertile of SES and 86% among those in the highest; for women, the rates were 83% and 77%, respectively. The differences in median survival times between persons in the lower and upper tertiles of SES were 80 days for men and 130 days for women. Among patients who visited a day clinic, for patients in the lowest tertile of SES versus those in the highest, the adjusted hazard ratio was 1.41 (95% confidence interval: 1.26, 1.57); for those admitted to the hospital, it was 1.14 (95% confidence interval: 1.07, 1.20). In summary, lower SES was associated with a higher mortality risk in both men and women with dementia. The results of the present study should raise awareness in clinicians and caregivers about the unfavorable prognosis in the most deprived patients.
ObjectiveTo report mortality risks of dementia based on national hospital registry data, and to put these risks into perspective by comparing them with those in the general population and following cardiovascular diseases.DesignProspective cohort study from 1 January 2000 through 31 December 2010.SettingHospital-based cohort.ParticipantsA nationwide hospital-based cohort of 59 201 patients with clinical diagnosis of dementia (admitted to a hospital or visiting a day clinic) was constructed (38.7% men, 81.4 years (SD 7.0)).Main outcomes and measures1-year and 5-year age-specific and sex-specific mortality risks were reported for patients with dementia visiting a day clinic compared with the general population; for patients hospitalised with dementia compared with patients hospitalised for acute myocardial infarction (AMI), heart failure or stroke, these were presented as absolute and relative risks (RRs).Results1-year mortality was 38.3% in men and 30.5% in women. 5-year risk was 65.4% and 58.5%, respectively. Mortality risks were significantly higher in patients with dementia admitted to the hospital than in those visiting a day clinic (1-year RR 3.29, 95% CI 3.16 to 3.42; and 5-year RR 1.79, 95% CI 1.76 to 1.83). Compared with the general population, mortality risks were significantly higher among patients visiting a day clinic (1-year RR for women 2.99, 95% CI 2.84 to 3.14; and for men 3.94, 95% CI 3.74 to 4.16). 5-year RRs were somewhat lower, but still significant. Results were more pronounced at younger ages. Mortality risks among admitted patients were comparable or even exceeded those of cardiovascular diseases (1-year RR for women with dementia vs AMI 1.24, 95% CI 1.19 to 1.29; vs heart failure 1.05, 95% CI 1.02 to 1.08; vs stroke 1.07, 95% CI 1.04 to 1.10). 5-year RRs were comparable. For men, RRs were slightly higher.ConclusionsDementia has a poor prognosis as compared with other diseases and the general population. The risks among admitted patients even exceeded those following cardiovascular diseases.
OBJECTIVES:To assess the effect of cardiovascular diseases and risk factors on mortality in individuals with dementia. DESIGN: Systematic review and meta-analysis. Englishand Dutch-language studies in PubMed, EMBASE, and PsycINFO databases were searched in April 2014 with hand-searching of in-text citations and no publication limitations. Inclusion criteria were original studies reporting on cardiovascular risk factors or diseases and their relationship with survival in individuals with dementia. The Quality In Prognosis Studies tool was used to appraise all included articles. SETTING: Population-, hospital-, and nursing homebased. PARTICIPANTS: Community-dwelling, hospitalized individuals and nursing home residents with dementia. MEASUREMENTS: A random-effects meta-analysis was performed to investigate the effect of several cardiovascular diseases and risk factors on overall mortality. RESULTS: Twelve studies with 235,865 participants were included. In pooled analyses, male sex (hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.56-1.78), diabetes mellitus (DM) (HR = 1.49, 95% CI = 1.33-1.68), smoking (ever vs never) (HR = 1.37, 95% CI = 1.17-1.61), coronary heart disease (CHD) (HR = 1.21, 95% CI = 1.02-1.44) and congestive heart failure (CHF) (HR = 1.37, 95% CI = 1.18-1.59) were associated with mortality. Stroke, high blood pressure, being overweight, and hypercholesterolemia were not statistically significantly related to mortality. CONCLUSION: Individuals with dementia and DM, smoking, CHD, and CHF have a greater risk of death than individuals with dementia without these risk factors or diseases. J Am Geriatr Soc 64:37-46, 2016.Key words: cardiovascular disease; dementia; metaanalysis; prognosis; review D ementia is a severe disease with an often poor prognosis. The literature suggests that mortality risk of individuals with dementia is at least twice as high as mortality risk of persons without dementia, with even higher risks in younger individuals.1,2 The burden of dementia is steadily rising, and it is expected that dementia will be the leading cause of death in the near future.3 Survival time ranges broadly 4 and ultimately depends on underlying risk factors including sex, age, socioeconomic factors, type of dementia, and presence of comorbidity (e.g., cardiovascular disease (CVD)). 5,6 CVD and dementia are closely related because they share many risk factors (RFs), and vascular diseases are the second most common cause of dementia.7 Research on the relationship between CVD, RFs, and dementia has focused mainly on the development of dementia in the presence of CVD and RFs. These factors increase the incidence of dementia. 8 In contrast, the effect of these factors on the progression of dementia is less consistent, and the effect on mortality risk in individuals with dementia is not clear at all. 9Information on the effect of CVD and RFs on the prognosis of individuals with dementia is valuable for individuals, caregivers, and clinicians because the estimated prognosis inevitably determines decis...
Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.