Who Is Providing the Predominant Care for Older Adults With Dementia?
To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings.



Cross-sectional analysis.



Fee-for-service Medicare beneficiaries aged ≥65 years with dementia.



Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits.



Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (P < .001).



It is unknown whether specialists are aware of their central role for many dementia patients' care needs. In LTC, NPs play the lead role as PPCs.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Mia
M
Yang
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Chiang-Hua
CH
Chang
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
Donald
D
Carmichael
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.
Esther S
ES
Oh
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Electronic address: Julie.PW.Bynum@dartmouth.edu.
Julie P W
JP
Bynum
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D011320:Primary Health Care; D013038:Specialization; D014481:United States
Medicare; Predominant provider; dementia; long-term care; primary care; specialist