The Prevalence of Dementia in a Statewide Sample of New Nursing Home Admissions Aged 65 and Older

Abstract

This study estimated the prevalence of dementia in 2,285 new admissions age 65+ to a statewide sample of 59 nursing homes in Maryland, 1992-1995. Dementia was ascertained according to DSM-III-R criteria by an expert panel of geriatric psychiatrists, neurologists, and a geriatrician using detailed information collected by trained lay evaluators from residents, family, staff, and medical records. Admissions to Maryland nursing homes are similar to admissions to nursing homes elsewhere in the United States. The prevalence of dementia was 48.2% (CI: 43.6-52.8) with an upper bound estimated at 54.5% (CI: 49.9-59.1). Prevalence is highest in facilities with <50 beds versus 200+ beds (65.5% vs 39.6%) and those in urban versus rural areas (50.0% vs 39.1%). Those who are non-White, married, and with fewer years of education are more likely to be demented. Prevalence is highest among those with 4+ physical impairments versus 0-1 (60.3% vs 27.7%) and lowest in those with 4+ comorbidities versus 0-1 (44.8% vs 52.0%). There was considerable overlap in the comorbid status of demented and nondemented admissions, and both groups contained members with only a few functional limitations. Results suggest that the level of medical supervision provided in nursing homes may not be required for some residents with dementia.

Medicare Cost Differences Between Nursing Home Patients Admitted With and Without Dementia

“…A statewide sample of newly admitted residents from 59 Maryland nursing facilities was identified and recruited between 1992 and 1995 using a twostage process, as reported previously (Magaziner et al, 2000). Facilities were randomly selected and recruited to be representative of all nursing homes statewide.…”

“…A detailed description of the dementia ascertainment methodology is available elsewhere (Magaziner et al, 1996). In the overall study population (N = 2,285), we designated 48.2% as having dementia (Magaziner et al, 2000).…”

“…Various investigators, including O'Brien and Caro (2001), identified dementia cases using diagnosis codes derived from medical charts. In addition to the problem of inconsistent coding of dementia across charts, it has been shown that chart-based methods underestimate the true prevalence of dementia in nursing homes by as much as 30% (Magaziner et al, 1996;Magaziner et al, 2000). The Kane and Atherly (2000) study identified dementia cases based on proxy reports of dementia, which lack standardized diagnostic criteria and raise the possibility of recall bias.…”

Pain Management in Nursing Home Residents with Cancer and Dementia with and without Hospice Services

“…The annual mortality rate in nursing homes varies from 24% to 32% (Dobbs, Hanson, Zimmerman, Williams, & Munn, 2006), and first-year mortality rates hover around 34% . Investigators have found that nearly 50% of the nursing home population has dementia (Magaziner, et al, 2000). Clearly, significant numbers of older adults live and die in nursing homes.…”

“…Hospice can positively benefit end-of-life symptom management where about a fourth of adult deaths in the U.S. now occur (Ersek & Wilson, 2003;Hanson, Sengupta, et al, 2005). Almost 50% of nursing home residents have dementia (Magaziner, et al, 2000) and the prevalence of pain or painful conditions is estimated to be between 49% and 83% among residents with dementia (Bjoro & Herr, 2008). This means that of the approximately 800,000 residents in the U.S. who die in nursing homes, over 400,000 have dementia and 650,000 have pain.…”