Effect of Early Referral to Specialist in Dementia on Institutionalization and Functional Decline: Findings from a Population-Based Study
Number of Authors: 8
2015 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 49, no 3, 819-828 p.Article in journal (Refereed) Published
Background: Although early diagnosis has been hypothesized to benefit both patients and caregivers, until nowstudies evaluating the effect of early dementia diagnosis are lacking. Objective: To investigate the influence of early specialist referral for dementia on the risk of institutionalization and functional decline in Activity of Daily Living (ADL). Methods: Incident dementia cases were screened in a prospective population-based cohort, the Three-City Study, and initial specialist consultation for cognitive complaint was assessed at dementia diagnosis. Proportional hazard regression and illness-death models were used to test the association between specialist referral and, respectively, institutionalization and functional decline. Results: Only one third of the incident individuals with dementia had consulted a specialist for cognitive problems early (36%). After adjustment on potential confounders (including cognitive and functional decline) and competing risk of death, participants who had consulted a specialist early in the disease course presented a higher rate of being institutionalized than those who did not (Hazard Ratio = 2.00, 95% Confidence Interval (CI): 1.09-3.64). But early specialist referral was not associated with further functional decline (HR = 1.09, 95% CI: 0.71-1.67). Conclusions: Early specialist referral in dementia is associated with increased risk of institutionalization but not with functional decline in ADL. These findings suggest that early care referral in dementia may be a marker of concern for patients and/or caregivers; subsequent medical and social care could be suboptimal or inappropriate to allow patients to stay longer at home.
Place, publisher, year, edition, pages
2015. Vol. 49, no 3, 819-828 p.
Dementia, dependency, institutionalization, population-based study, secondary care
IdentifiersURN: urn:nbn:se:su:diva-125887DOI: 10.3233/JAD-150574ISI: 000367104100020OAI: oai:DiVA.org:su-125887DiVA: diva2:896163