The effect of the living situation on the severity of dementia at diagnosis.
BACKGROUND
Previous studies have shown that social determinants not directly involved in the disease process may be implicated in the timing of dementia diagnosis. This study explores the relationship between a patient's living situation and the severity of dementia at diagnosis.


METHODS
Data were collected from the baseline interviews of 1,325 patients with cognitive decline enrolled in the Consortium for the Investigation of Vascular Impairment of Cognition study. Data collected included: age, sex, living situation and scores on the Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), the Functional Rating Scale (FRS), the Disability Assessment for Dementia (DAD) scale and the Cumulative Illness Rating Scale (CIRS). Living situation was grouped as: (1) lives alone, (2) lives with spouse, (3) lives with child, relative or other and (4) lives in a nursing home. A general linear model univariate analysis was used to compare patients by their respective living situations for differences in mean scores on each of the 4 measures of dementia severity.


RESULTS
Statistical analysis of both unadjusted data and data adjusted for age, sex and CIRS scores showed significant differences among the groups. Those who lived alone were diagnosed at an earlier stage (mean scores: MMSE 21.4, GDS 3.6, FRS 20.0, DAD 29.8) followed by those who lived with a spouse (mean scores: MMSE 20.5, GDS 3.7, FRS 20.4, DAD 28.0), those who lived with a child or other (mean scores: MMSE 19.3, GDS 3.9, FRS 22.5, DAD 24.9) and finally those who lived in a nursing home (mean scores: MMSE 15.2, GDS 4.8, FRS 27.5, DAD 16.9).


CONCLUSIONS
Living situation is related to the severity of dementia at diagnosis. Primary care providers should have a low threshold for case-finding in older adults who live with family or friends.
Sibley
A
A
Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
MacKnight
C
C
Rockwood
K
K
Fisk
J
J
Gauthier
S
S
Guzman
D A
DA
Hogan
D B
DB
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D015140:Dementia, Vascular / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006701:Home Nursing / Q000523:psychology*; D006801:Humans; D007326:Institutionalization; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012959:Socioeconomic Factors