Brück Chiara C, Mooldijk Sanne S, Kuiper Lieke M, Sambou Muhammed L, Licher Silvan, Mattace-Raso Francesco, Wolters Frank J
Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands.
Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, Netherlands.
BMJ. 2025 Jan 8;388:e080636. doi: 10.1136/bmj-2024-080636.
To summarise available evidence on time to nursing home admission and death among people with dementia, and to explore prognostic indicators.
Systematic review and meta-analysis.
Medline, Embase, Web of Science, Cochrane, and Google Scholar from inception to 4 July 2024.
Longitudinal studies on survival or nursing home admission in people with dementia. Studies with fewer than 150 participants, recruitment during acute hospital admission, or less than one year of follow-up were excluded.
19 307 articles were identified and 261 eligible studies included. 235 reported on survival among 5 553 960 participants and 79 reported on nursing home admission among 352 990 participants. Median survival from diagnosis appeared to be strongly dependent on age, ranging from 8.9 years at mean age 60 for women to 2.2 years at mean age 85 for men. Women overall had shorter survival than men (mean difference 4.1 years (95% confidence interval 2.1 to 6.1)), which was attributable to later age at diagnosis in women. Median survival was 1.2 to 1.4 years longer in Asia than in the US and Europe, and 1.4 years longer for Alzheimer's disease compared with other types of dementia. Compared with studies before 2000, survival was longer in contemporary clinic based studies (P=0.02), but not in community based studies. Taken together, variation in reported clinical characteristics and study methodology explained 51% of heterogeneity in survival. Median time to nursing home admission was 3.3 years (interquartile range 1.9 to 4.0). 13% of people were admitted in the first year after diagnosis, increasing to 57% at five years, but few studies appropriately accounted for competing mortality risk when assessing admission rates.
The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women. About one third of remaining life expectancy was lived in nursing homes, with more than half of people moving to a nursing home within five years after a dementia diagnosis. Prognosis after a dementia diagnosis is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning.
PROSPERO CRD42022341507.
总结有关痴呆症患者入住养老院时间和死亡情况的现有证据，并探索预后指标。
系统评价和荟萃分析。
从创刊至2024年7月4日的Medline、Embase、Web of Science、Cochrane和谷歌学术。
关于痴呆症患者生存或入住养老院的纵向研究。排除参与者少于150人的研究、急性住院期间招募的研究或随访时间少于一年的研究。
共识别出19307篇文章，纳入261项符合条件的研究。235项研究报告了5553960名参与者的生存情况，79项研究报告了352990名参与者入住养老院的情况。从诊断开始的中位生存期似乎强烈依赖于年龄，女性平均年龄60岁时为8.9年，男性平均年龄85岁时为2.2年。总体而言，女性的生存期比男性短（平均差异4.1年（95%置信区间2.1至6.1）），这归因于女性诊断时年龄较大。亚洲的中位生存期比美国和欧洲长1.2至1.4年，阿尔茨海默病患者的中位生存期比其他类型痴呆症患者长1.4年。与2000年前的研究相比，当代基于诊所的研究中生存期更长（P=0.02），但基于社区的研究并非如此。综合来看，报告的临床特征和研究方法的差异解释了生存期异质性的51%。入住养老院的中位时间为3.3年（四分位间距1.9至4.0）。13%的人在诊断后的第一年内入住养老院，五年时增至57%，但在评估入住率时，很少有研究适当考虑竞争死亡风险。
痴呆症患者诊断时的平均预期寿命，男性65岁时为5.7年，85岁时为2.2年；女性分别为8.0年和4.5年。剩余预期寿命中约三分之一是在养老院度过的，超过一半的人在痴呆症诊断后的五年内入住养老院。痴呆症诊断后的预后高度依赖于个人和临床特征，为个性化预后信息和护理计划提供了可能性。
PROSPERO CRD42022341507
