Early Start of Anti-Dementia Medication Delays Transition to 24-Hour Care in Alzheimer's Disease Patients: A Finnish Nationwide Cohort Study

Olli Halminen, Aino Vesikansa*, Juha Mehtälä, Iiris Hörhammer, Teija Mikkola, Lauri J. Virta, Tero Ylisaukko-Oja, Miika Linna

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: Dementia is one of the strongest predictors of admission to a 24-hour care facility among older people, and 24-hour care is the major cost of Alzheimer's disease (AD). Objective: The aim of this study was to evaluate the association of early start of anti-dementia medication and other predisposing factors with 2-year risk of transition to 24-hour care in the nationwide cohort of Finnish AD patients. Methods: This was a retrospective, non-interventional study based on individual-level data from Finnish national health and social care registers. The incident cohort included 7,454 AD patients (ICD-10, G30) comprised of two subgroups: those living unassisted at home (n = 5,002), and those receiving professional home care (n = 2,452). The primary outcome was admission to a 24-hour care facility. Exploratory variables were early versus late anti-dementia medication start, sociodemographic variables, care intensity level, and comorbidities. Results: Early anti-dementia medication reduced the risk of admission to 24-hour care both in patients living unassisted at home, with a hazard ratio (HR) of 0.58 (p < 0.001), and those receiving professional home care (HR, 0.84; p = 0.039). Being unmarried (HR, 1.69; p < 0.001), having an informal caregiver (HR, 1.69; p = 0.003), or having a diagnosis of additional neurological disorder (HR, 1.68; p = 0.006) or hip fracture (HR, 1.61; p = 0.004) were associated with higher risk of admission to 24-hour care in patients living unassisted at home. Conclusion: To support living at home, early start of anti-dementia medication should be a high priority in newly diagnosed AD patients.

Original languageEnglish
Pages (from-to)1103-1115
Number of pages13
JournalJournal of Alzheimer's Disease
Volume81
Issue number3
DOIs
Publication statusPublished - 2021
MoE publication typeA1 Journal article-refereed

Keywords

  • Alzheimer's disease
  • cholinesterase inhibitors
  • dementia
  • Finland
  • healthcare
  • institutionalization
  • memantine
  • nursing homes
  • register

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