Older adults who receive a dementia diagnosis in a hospital or nursing home have significantly lower survival rates than those disease was diagnosed in the community, a new study shows.
Receiving a diagnosis during an acute illness, care transition or at a later stage in the disease is suboptimal, researchers said, because “this could reflect delayed diagnosis or misdiagnosis, and may reflect underlying disparities in healthcare access.”
The report was published Tuesday in the Journal of the American Geriatrics Society.
Investigators examined Medicare claims and administrative data from 2012 through 2020 for more than 750,000 people in whom dementia initially was diagnosed in 2016 and who were fee-for-service Medicare beneficiaries. The team’s goal was to determine whether there was a link between outcomes and where the disease was diagnosed.
They found that 60.3% of the people included in the study received their diagnoses in the community, 17.2% in the hospital and 22.5% in a nursing home.
When the team looked at four-year survival rates, they observed that the rates were 16.1 percentage points lower among receiving diagnoses in hospitals and 16.8 percentage points lower for those receiving diagnoses in nursing homes compared with those receiving diagnoses in the community.
That is, the unadjusted survival rates four years after receiving a diagnosis included 50.7% of people in the community compared with 30.8% in hospitals to 25.7% in nursing homes
Interestingly, those receiving diagnoses in the community were more often female, younger, had fewer baseline hospitalizations and higher home care use, and resided in wealthier areas. They were more apt to be Asian or Pacific Islander, Native American or Alaskan Native, and Hispanic. Rural beneficiaries were more likely to receive diagnoses in hospitals.
“Structural disparities must be addressed to improve dementia diagnosis, particularly for individuals in rural areas and communities with higher social deprivation. Improved access to clinicians with geriatric expertise in these communities; and increased dementia training for primary care providers, social workers, nurses, and other clinicians working in these areas may help to improve the timeliness and accuracy of dementia diagnosis, and facilitate referral to appropriate resources,” the authors wrote.
