OBJECTIVE: To summarise available evidence on time to nursing home admission and death among people with dementia, and to explore prognostic indicators.
DESIGN: Systematic review and meta-analysis.
DATA SOURCES: Medline, Embase, Web of Science, Cochrane, and Google Scholar from inception to 4 July 2024.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Longitudinal studies on survival or nursing home admission in people with dementia. Studies with fewer than 150 participants, recruitment during acute hospital admission, or less than one year of follow-up were excluded.
RESULTS: 19 307 articles were identified and 261 eligible studies included. 235 reported on survival among 5 553 960 participants and 79 reported on nursing home admission among 352 990 participants. Median survival from diagnosis appeared to be strongly dependent on age, ranging from 8.9 years at mean age 60 for women to 2.2 years at mean age 85 for men. Women overall had shorter survival than men (mean difference 4.1 years (95% confidence interval 2.1 to 6.1)), which was attributable to later age at diagnosis in women. Median survival was 1.2 to 1.4 years longer in Asia than in the US and Europe, and 1.4 years longer for Alzheimer's disease compared with other types of dementia. Compared with studies before 2000, survival was longer in contemporary clinic based studies (Ptrend=0.02), but not in community based studies. Taken together, variation in reported clinical characteristics and study methodology explained 51% of heterogeneity in survival. Median time to nursing home admission was 3.3 years (interquartile range 1.9 to 4.0). 13% of people were admitted in the first year after diagnosis, increasing to 57% at five years, but few studies appropriately accounted for competing mortality risk when assessing admission rates.
CONCLUSIONS: The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women. About one third of remaining life expectancy was lived in nursing homes, with more than half of people moving to a nursing home within five years after a dementia diagnosis. Prognosis after a dementia diagnosis is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022341507.
| Discipline Area | Score |
|---|---|
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Neurology |  |
| Psychiatry | |
| Geriatrics |  |
This study has a good level of evidence (systematic review and meta-analysis) and the results are relevant to assist in care of the elderly with dementia, especially the decision-making process related to care planning and quality-of-life.
This systemic review concludes that prognosis after a dementia diagnosis is variable and highly dependent on patient characteristics. We know this.
For almost any disease, it is hazardous to apply average life-expectancy to an individual case, since most will die sooner or later than average. Nevertheless, a general ballpark average can be useful.
For residents admitted to LTC with dementia, the average time to death that I've seen is 18 months.
This number had proven true since 2020. Residents are admitted less well, more frail, and often need end-of-life care. They are further along in their disease trajectory. I have observed that if a resident does not rally within 6 weeks of admission, they often die by 3 months.
