Time to nursing home admission and death in people with dementia: systematic review and meta-analysis

OBJECTIVE: To summarise available evidence on time to nursing home admission and death among people with dementia, and to explore prognostic indicators. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Web of Science, Cochrane, and Google Scholar from inception to 4 July 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Longitudinal studies on survival or nursing home admission in people with dementia. Studies with fewer than 150 participants, recruitment during acute hospital admission, or less than one year of follow-up were excluded. RESULTS: =0.02), but not in community based studies. Taken together, variation in reported clinical characteristics and study methodology explained 51% of heterogeneity in survival. Median time to nursing home admission was 3.3 years (interquartile range 1.9 to 4.0). 13% of people were admitted in the first year after diagnosis, increasing to 57% at five years, but few studies appropriately accounted for competing mortality risk when assessing admission rates. CONCLUSIONS: The average life expectancy of people with dementia at time of diagnosis ranged from 5.7 years at age 65 to 2.2 at age 85 in men and from 8.0 to 4.5, respectively, in women. About one third of remaining life expectancy was lived in nursing homes, with more than half of people moving to a nursing home within five years after a dementia diagnosis. Prognosis after a dementia diagnosis is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022341507.