Objectives: To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times.
Design: Markov multistate survival analysis and flexible parametric models.
Setting: Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data.
Participants: 2,938 home-dwelling persons with dementia, ages 40-97 years at time of diagnosis (mean 76.1, SD 8.5).
Results: During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group.
Conclusion: Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.
Introduction
There is a huge amount of information on SARS-CoV-2 (COVID-19), but its influence on mental health is still lacking. Although all age groups are at risk of contracting COVID-19, older people face significant risk of developing severe illness (Kluge, Reference Kluge2020). The old age is an independent factor for the COVID-19-related death (RR = 9.45) (Zhao et al., Reference Zhao2020). This pandemic might affect this population’s mental health. Retrospective studies of the Severe Acute Respiratory Syndrome epidemic demonstrated that suicide rates raised among elderly during this period (Kluge, Reference Kluge2020). This data emphasize the urgency of studying COVID-19 mental health impact in real time, since it has brought consequences such as psychological suffering, fear, depression and anxiety (Courtin and Knapp, Reference Courtin and Knapp2017; Fiorillo and Gorwood, Reference Fiorillo and Gorwood2020).
Researchers and health professionals from Brazil, Norway and Portugal documented their health professional experiences facing this novel pandemic to advise health services. These countries were selected due to their position in the worldwide ranking on the 2019 Human Development (HD) Report (http://www.hdr.undp.org/en/2019-report). HD classifies countries according to indices such as economic and gender inequality, health, education, dignity and respect for human rights. Among the 100 countries in that report, Norway (1st), Portugal (40th) and Brazil (75th) are top, middle and bottom listed, respectively. Could the differences between these countries counteract the assistance to elderly in the COVID-19 pandemic age? This report aims to provide an overview of each country’s response from the authors’ perspective based on their informal interviews with a multidisciplinary health professional range.