Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland.
MedEngine Oy, Helsinki, Finland.
J Alzheimers Dis. 2021;81(3):1103-1115. doi: 10.3233/JAD-201502.
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).
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.
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.
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.
To support living at home, early start of anti-dementia medication should be a high priority in newly diagnosed AD patients.
痴呆症是老年人入住 24 小时护理机构的最强预测因素之一，而 24 小时护理是阿尔茨海默病（AD）的主要费用。
本研究旨在评估早期开始抗痴呆药物治疗和其他诱发因素与芬兰全国 AD 患者队列中 2 年过渡到 24 小时护理的风险之间的关联。
这是一项基于芬兰国家卫生和社会护理登记处个体水平数据的回顾性、非干预性研究。该病例队列包括 7454 名 AD 患者（ICD-10，G30），分为两个亚组：在家中无需帮助生活的患者（n=5002）和接受专业家庭护理的患者（n=2452）。主要结局是入住 24 小时护理机构。探索性变量为早期与晚期开始抗痴呆药物治疗、社会人口统计学变量、护理强度水平和合并症。
早期抗痴呆药物治疗降低了在家中无需帮助生活的患者（风险比 [HR]，0.58；p<0.001）和接受专业家庭护理的患者（HR，0.84；p=0.039）入住 24 小时护理机构的风险。未婚（HR，1.69；p<0.001）、有非正式照顾者（HR，1.69；p=0.003）、或有其他神经障碍诊断（HR，1.68；p=0.006）或髋部骨折（HR，1.61；p=0.004）的患者入住 24 小时护理机构的风险更高。
为了支持在家生活，在新诊断的 AD 患者中，早期开始抗痴呆药物治疗应是重中之重。
