Do People with Dementia Die Faster in Nursing Homes or at Home?

Factors that Affect Life Expectancy in Care Facilities

Man and woman walking down hallway of care facility
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Nursing homes are often thought of as a last resort, but sometimes a necessary one, for the care of people with dementia. The majority of people want to remain at home for as long as possible, and some may have even asked their family not to send them to a nursing home. One fear is that a loved one might decline, and eventually die, more quickly in a facility than he would at home. Is this accurate?

The short answer: It depends. The longer answer? There's limited research on this question, but there are certain factors that make decline and death in dementia more likely to occur.

Relevant Research

According to figures compiled in 2017, Alzheimer's disease and related dementias are the 6th leading cause of death in the United States. So, where do people with dementia die?

One study published in the Journal of the American Geriatrics Society involved more than 4,000 older adults who were studied for approximately five years. Researchers in this study tracked the deaths of the participants and found that almost half (46%) of those with dementia died at home, while 19% were at a nursing home and 35% were hospitalized when they died.

However, a previous study published in 2005 found that 2/3 of deaths relating to dementia happened in a nursing home.

A third study from 2013 analyzed 378 nursing home residents and found that those with a diagnosis of Alzheimer's disease-- as compared to those with other types of dementia and those with cardiovascular diagnoses-- actually survived for a longer period of time.

This finding seems counter-intuitive at first but could possibly be explained by understanding that nursing homes are caring for people who are more critically ill now than in the past, and thus perhaps those with conditions other than Alzheimer's may have a reduced life expectancy.

Factors Correlated with a Decreased Risk of Death in Dementia

While it's difficult to find research that addresses where people with dementia will die more quickly, there are a few factors that have been correlated with a longer lifespan in dementia.

They include the following:

  • Being Overweight: Ironically, while extra pounds in our middle age years increases our risk of developing dementia, extra pounds in older people with dementia is associated with a reduced risk of death in nursing homes. Weight loss in dementia, even in people who are obese, should be viewed with concern because of this correlation with an increased risk of death.
  • Reducing Antipsychotic Medications Combined with Social Interaction Programs: There is a strong push to decrease the use of antipsychotic medications for people with dementia in nursing homes, and as a nation, we have made much progress in this area. However, some research says that's not enough. It found that reducing the usage coupled with the provision of increased social interaction improved survival rates in facilities. Simply decreasing antipsychotic medications without adding other interventions resulted in an increase in the challenging behaviors and emotions related to dementia and did not improve survival rates.
  • Effective Treatment of Behavioral and Psychological Symptoms of Dementia: Another study of people with dementia in nursing homes compared the mortality rates of people who receiving anti-depressant medications to those who were receiving antipsychotic medications. They found that death rates were impacted not by whether or not someone was getting medicine or by which medicine they received, but by whether or not the medicine was effective in improving their BPSD. In other words, people in both groups (those on antidepressants and those on antipsychotics) lived longer if their behaviors and emotional symptoms of dementia improved with medicine.

    Factors Associated with an Increased Risk of Death in Dementia

    Conversely, research has associated these factors with a higher risk of dying for someone with dementia.

    • Delirium: The presence of delirium in people with dementia has been associated with an increased risk of death. One common cause of delirium is an infection.
    • Falls and Hip Fractures: People with dementia have an increased risk of falls and hip fractures, and that risk, in turn, is associated with an increased risk of dying.
    • Pressure Sores: Decubitus ulcers (also called "bed sores" increase the risk of death in those living with dementia. 
    • Inability to Perform ADLs: As dementia progresses, the ability to perform daily tasks such as dressing, bathing, eating or walking decrease. This decrease is related to an increased risk of dying. 
    • Pneumonia: Developing pneumonia poses an increased risk of death in people with dementia.
    • Age: Being 85 years old or older is associated with a significantly higher risk of death from Alzheimer's disease.

    Sources:

    Ballard, C., Orrell, M., YongZhong, et al.(2016). Impact of Antipsychotic Review and Nonpharmacological Intervention on Antipsychotic Use, Neuropsychiatric Symptoms, and Mortality in People With Dementia Living in Nursing Homes: A Factorial Cluster-Randomized Controlled Trial by the Well-Being and Health for People With Dementia (WHELD) Program. American Journal of Psychiatry, 173(3), pp.252-262.

    Cereda, E., Pedrolli, C., Zagami, A., Vanotti, A., Piffer, S., Faliva, M., Rondanelli, M. and Caccialanza, R. (2013). Alzheimer's disease and mortality in traditional long-term care facilities. Archives of Gerontology and Geriatrics, 56(3), pp.437-441.

    de Souto Barreto, P., Cadroy, Y., Kelaiditi, E., Vellas, B. and Rolland, Y. (2017). The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes. Clinical Nutrition, 36(2), pp.423-428.

    Hicks, K., Rabins, P. and Black, B. (2010). Predictors of Mortality in Nursing Home Residents With Advanced Dementia. American Journal of Alzheimer's Disease & Other Dementiasr, 25(5), pp.439-445.

    Huang, T., Wei, Y., Moyo, P., Harris, I., Lucas, J. and Simoni-Wastila, L. (2015). Treated Behavioral Symptoms and Mortality in Medicare Beneficiaries in Nursing Homes with Alzheimer's Disease and Related Dementias. Journal of the American Geriatrics Society, 63(9), pp.1757-1765.

    Mitchell, S., Miller, S., et al. (2010). The Advanced Dementia Prognostic Tool: A Risk Score to Estimate Survival in Nursing Home Residents with Advanced Dementia. Journal of Pain and Symptom Management, 40(5), pp.639-651.

    Seitz, D., Gill, S., Gruneir, A., et al.. (2014). Effects of Dementia on Postoperative Outcomes of Older Adults With Hip Fractures: A Population-Based Study. Journal of the American Medical Directors Association, 15(5), pp.334-341.

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