Most Seniors With Dementia Live at Home: Here’s Why

Highlights:

Most seniors with dementia in the US live at home rather than in nursing homes or residential facilities
This results in having to endure more pain, anxiety, depression, and poor health
Major reasons are the high cost of other facilities, familiarity with the home environment, as well as caregivers

Most seniors with dementia in the US live at home, despite having to endure more pain, anxiety and failing health, compared to their counterparts living in nursing homes or residential facilities, reveals a new study from the University of California San Francisco (UCSF), USA. The study findings have been published in the Journal of the American Geriatrics Society.

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‘Most seniors with dementia in the US live at home instead of nursing homes or residential facilities, despite enduring more pain, anxiety, and poor health. Reasons are cost, the familiarity of home surroundings, and consistent living environment and caregivers.’
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Study Team

The study was led by Dr. Alexander K. Smith, MD, MPH, MS, who is an Associate Professor of Medicine at the UCSF School of Medicine, USA. The first author of the paper was Dr. Krista Harrison, PhD, who is an Assistant Professor in the Division of Geriatrics, Department of Medicine, at the UCSF School of Medicine, USA.

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Key Features of the Study

728 elderly patients above 65 years of age with moderately severe dementia were included in the study

The patients were recruited from Medicare enrollees, representing a nationwide sample of senior citizens
Inclusion criteria included the following:

Moderately severe dementia diagnosed medically or by using a survey algorithm
Difficulty in performing everyday tasks such as dressing, bathing or using the toilet
Difficulty in performing mental tasks such as managing finances or taking medications at scheduled times

The medical characteristics of dementia patients were compared in the following three settings:

Patients living in their own homes
Patients living in nursing homes
Patients living in residential facilities

The medical characteristics of patients suffering from moderately severe dementia are very well described by Dr. Alexander Smith: “At this stage of dementia, patients may have difficulty recalling their address or personal history,” says Smith. “Communication becomes impaired and the individual may struggle to follow a conversation and become disoriented with respect to time and place. They may lack good judgment and experience mood and behavior changes.”

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Key Findings of the Study

499 patients (68.5%) lived in their own homes
126 patients (17.3%) lived in residential facilities
103 patients (14.1%) lived in nursing homes
Average age of patients living at home was 82 years, compared to 86 years for patients living in nursing homes
Living-at-home patients had more chronic conditions than nursing home patients – 3.2 vs 3.1
Living-at-home patients endured greater pain than nursing home patients – 70.8 percent vs 58.6 percent
Living-at-home patients suffered from more falls than nursing home patients – 67.1 percent vs 50.4 percent
Living-at-home patients had more anxiety than nursing home patients
Living-at-home patients had fair or poor health compared to nursing home patients who had good or excellent health

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Why is the Trend in Patients Staying at Nursing Homes Declining?

The main reason for the decline in patients staying in nursing homes is the cost factor, which is very expensive compared to staying at home. Moreover, dementia patients prefer the familiarity of their home surroundings. They also benefit much more from having consistent living environments, as well as the same recognizable caregiver, which is only available at home and not at nursing homes, where a variety of people attend to the patient. As a result of this new trend of moving away from nursing homes, Medicaid spending for community and home-based health services have been increased, compared to spending on institutional healthcare.

What Makes Residential Facility Patients Different from the Others?

The major differences between dementia patients residing in residential facilities and those residing at home or in nursing homes, include the following:

They comparatively suffer less from depression, anxiety, and chronic conditions
They are comparatively more affluent and have higher incomes
Most of them are US-born citizens
Majority of them have post-high-school education
They are less likely to be married (16.4%) compared to patients living at home (45.1%) or in nursing homes (21.8%)

Concluding Remarks

Home care services could immensely benefit dementia patients. These health services for patients living at home could reduce the chances of developing disability, depression and anxiety disorders, as well as fewer hospital visits. It would also have a positive impact on the health of caregivers. Although home-based medical care services are slowly growing, still only about 12 percent of patients living in their own homes currently receive these services.

“Some people with dementia who live at home receive home-based primary, geriatric or palliative care, but many more likely do not,” says Harrison. “There is an urgent need for these services – as well as home health aides and other social supports – to become widely available to those families providing home care for loved ones with dementia.”

Funding Source

The study was funded by the National Institute on Aging, National Center for Advancing Translational Sciences and the US Department of Veterans Affairs.

Reference:

Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia - (https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.16054)

Source-Medindia