Life expectancy and nursing home entry in people with dementia

Life expectancy and nursing home entry in people with dementia

The average life expectancy of people diagnosed with dementia ranges from 9 years at age 60 to 4.5 years at age 85 for women and from 6.5 to just over 2 years for men, a systematic review of the latest evidence finds in The BMJ Today.

The results also suggest that a third of people with dementia are admitted to a nursing home within three years of diagnosis.

Nearly 10 million people worldwide receive a diagnosis of dementia each year, but survival estimates vary widely and few studies have assessed prognosis (the likely course of the disease) in relation to nursing home admission.

To better understand this, researchers in the Netherlands wanted to determine the prognosis for people with a diagnosis of dementia, both in terms of remaining life expectancy and the time to nursing home admission.

Their findings are based on 261 studies published between 1984 and 2024 (235 on survival and 79 on nursing home entry) involving more than 5 million people with dementia (mean age 79, 63% women).

Studies were mainly from Europe and North America with an average follow-up of 7 years.

After assessing study quality, researchers found that average survival from diagnosis was highly dependent on age, ranging from 8.9 years at an average age of 60 for women to 2.2 years at an average age of 85 for men.

Overall, dementia reduced life expectancy by about two years for people diagnosed at age 85, 3 to 4 years diagnosed at age 80, and diagnosed at age 65.

Average survival was up to 1.4 years longer in Asian populations and 1.4 years longer in people with Alzheimer's disease compared to other types of dementia.

The average entry into nursing homes was just over 3 years, with 13% of people admitted in the first year after diagnosis, rising to a third (35%) after three years and more than half (57%) after five years. However, the authors note that these estimates are less reliable and should be interpreted with caution.

These are observational results and the authors acknowledge that differences in study methods and inconsistent reporting of measures such as socioeconomic status, race, disease severity, and pre-existing medical conditions influenced their estimates.

However, they note that careful search and data extraction enabled analyzes of the largest number of studies over a longer period of time, "offering the potential for individualized prognostic information and care planning."

They conclude: "Future studies of individualized prognosis should ideally include patients at the time of diagnosis, extent of personal factors, social factors, disease stage and comorbidity, while assessing relevant functional outcome measures via survival alone."

In a linked editorial, researchers from Norway say although understanding of survival with dementia has advanced significantly, the complexity of predicting the timeline for nursing home approval remains

“To improve future healthcare services and optimize the quality of life of people with dementia and their families, it is important that we continue to strive for more precise, context-sensitive insights,” they conclude.

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