Affiliations: [a]
Department of Industrial Engineering and Management, School of Science, Aalto University, Espoo, Finland
| [b] MedEngine Oy, Helsinki, Finland
| [c] Ministry of Finance Finland | [d] Social Insurance Institution Finland | [e] Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
Correspondence:
[*]
Correspondence to: Aino Vesikansa, PhD, MedEngine Oy, FI-00130 Helsinki, Finland. Tel.: +358 50 307 9128; E-mail: aino.vesikansa@medengine.fi.
Abstract: Background: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). Objective: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. Methods: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. Results: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. Conclusion:To support living at home, early start of anti-dementia medication should be a high priority in newly diagnosed AD patients.
