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Who Is Providing the Predominant Care for Older Adults With Dementia?

Mia Yang¹, Chiang-Hua Chang², Donald Carmichael²

¹Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Journal of the American Medical Directors Association

|June 15, 2016

Abstract

Objectives:

To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings.

Design:

Cross-sectional analysis.

Participants:

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

Measurements:

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.

Results:

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).

Conclusion:

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.

Keywords:

Medicare Predominant provider dementia long-term care primary care specialist

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