• Gregory Huyer, Brown Catherine R L CRL Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Mana, Sarah Spruin, Amy T Hsu, Stacey Fisher, Douglas G Manuel, Susan E Bronskill, Danial Qureshi, and Peter Tanuseputro.
• Clinical Epidemiology Program (Huyer, Brown, Hsu, Fisher, Manuel, Qureshi, Tanuseputro), Ottawa Hospital Research Institute; Telfer School of Management (Huyer) and School of Epidemiology and Public Health (Brown, Fisher, Tanuseputro), University of Ottawa; Bruyere Research Institute (Hsu, Qureshi, Tanuseputro); ICES uOttawa (Spruin, Hsu, Manuel, Tanuseputro), Ottawa, Ont.; ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Bronskill), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
• CMAJ. 2020 Apr 20; 192 (16): E422-E430.

BackgroundAfter diagnosis of a health condition, information about survival and potential transition from community into institutional care can be helpful for patients and care providers. We sought to describe the association between a new diagnosis of dementia and risk of admission to a long-term care home and death at 5 years.MethodsWe conducted a population-based retrospective cohort study using linked health administrative databases. We identified individuals aged 65 years or older, living in the community, with a first documented diagnosis of dementia between Jan. 1, 2010, and Dec. 31, 2012, in Ontario, Canada. Dementia diagnosis was captured using diagnostic codes from hospital discharges, physician billings, assessments conducted for home care and long-term care, and dispensed prescriptions for cholinesterase inhibitors. Our primary outcome measures were 5-year risk of death and placement in a long-term care home, adjusted for sociodemographic and clinical factors.ResultsWe identified 108 757 individuals in our study cohort. By the end of 5 years, 24.4% remained alive in the community and 20.5% were living in a long-term care home. Of the 55.1% who died, about half (27.9%) were admitted to a long-term care home before death. Three risk factors were associated with increased odds of death: older age (age ≥ 90 yr; odds ratio [OR] 9.5, 95% confidence interval [CI] 8.8-10.2 [reference: age 65-69 yr]), male sex (OR 1.7, 95% CI 1.6-1.7), and the presence of organ failure, including chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.7-1.8), congestive heart failure (OR 2.0, 95% CI 1.9-2.0) and renal failure (OR 1.7, 95% CI 1.6-1.8). Groups formed by combinations of these 3 factors had an observed 5-year risk of death varying between 22% and 91%.InterpretationAmong community-dwelling older adults with newly identified dementia in Ontario, the majority died or were admitted to a long-term care home within 5 years. This information may be helpful for discussions on prognosis and need for admission to long-term care.© 2020 Joule Inc. or its licensors.

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