Social factors and the outcome of dementia

Previous studies have linked reduced survival in dementia with male sex, older age, longer duration of illness and increased severity of cognitive impairment. However, little is known about the potential influence of social factors (such as life events and social support) on the outcome of dementia. Sixty recently admitted patients with dementia (27 in-patients and 33 day patients) were given detailed psychiatric and social assessments. These included information on life events and social supports. At follow-up, 3 years later, data were collected on outcome. The hypotheses were that adverse life events and lack of social support would be associated with reduced survival. Nearly half the patients (48%) died during the follow-up period. The experience of life events before the first assessment was not associated with outcome. However, receiving meals on wheels (p=0.01) was associated with reduced survival, while attending a day centre (p=0.06) and having support from relatives (p=0.06) were associated with increased survival. Higher dependency (p=0.004) and poorer physical health (p=0.07) were associated with reduced survival. These results suggest that factors related to social support are associated with the outcome of dementia. In particular, receiving meals on wheels or home help may be a marker of a lack of social support, which influences outcome. Further studies are required to examine these associations in more detail.