Us Administration on Again How Many People With Dementia Live Alone
J Alzheimers Dis. 2016; 52(2): 619–629.
Published online 2022 May 10. Prepublished online 2022 Mar 25. doi:10.3233/JAD-151058
Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services
Tilly Eichler
aGerman Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
Wolfgang Hoffmann
aGerman language Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
bFound for Community Medicine, University Medicine Greifswald, Greifswald, Federal republic of germany
Johannes Hertel
aGerman Heart for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
cDepartment of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Frg
Steffen Richter
aHigh german Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
Diana Wucherer
aGerman Eye for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
Bernhard Michalowsky
aGerman Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
Adina Dreier
aGerman Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
bInstitute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
Jochen René Thyrian
aGerman Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Deutschland
Roberto Monastero, Handling Associate Editor
Abstruse
Background: Petty is known well-nigh the proportion and the characteristics of community-home people with dementia (PWD) living alone in Germany.
Objectives: To analyze the prevalence of PWD living lone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics also as health and nursing care utilization associated with living alone.
Methods: DelpHi-MV (Dementia: Life- and person-centered help in Mecklenburg-Western Pomerania) is a full general practitioner-based, randomized controlled intervention trial. The nowadays analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9).
Results: North = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more than oft female person, older, and more often widowed than those not living solitary. About nine% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, low, falls, number of drug-related problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such equally home intendance, help with medication, home-delivered meals, or housekeeping assistance significantly more ofttimes. Multivariate analyses confirmed these findings.
Conclusion:Our results reveal the high proportion of PWD living lone in Germany. PWD living alone did non seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing intendance services for PWD living alone, providers should consider the present results for time to come planning.
Keywords: Ambulatory care, dementia, living arrangements, primary health care
INTRODUCTION
About iii-quarters of the estimated one.five million people with dementia (PWD) in Deutschland live at domicile [1, ii]. Information technology is likely that a significant proportion of these people live in unmarried households. For the U.s.a. (US) [3] and the Uk (UK) [4], it is estimated that up to one-third of community-dwelling PWD live lone. Previous studies showed that PWD living alone tend to exist older, more oftentimes female, more than likely to live in poverty, less cognitively impaired, to have fewer impairments in activities of daily living, and a higher gamble to be socially isolated than PWD who do not alive alone. In addition, they take more unmet needs, less access to health intendance, higher risks of problems with medication, untreated medical weather, falls and injuries, earlier nursing abode transition, and inadequate self-intendance such as malnutrition, poor hygiene, or inadequate clothing or housing. These risks increase with the progression of the illness [iii–8].
As people grow older, they are not merely more likely to live solitary—demographic and societal changes issue in an increasing number of PWD who do not have any relative, friend, or neighbor close by who can take care of them. Risks that are associated with living alone are probable to exacerbate fifty-fifty further if PWD alive alone without the support of an informal caregiver. So far, very little is known well-nigh this group of patients, because the absence of an informal caregiver is often an exclusion criterion in dementia care research. Information technology has been estimated that upwardly to one-third to one-half of PWD live alone without an identifiable caregiver in the US [three].
To our knowledge, there are no primary information available about the proportion and the characteristics of community-dwelling PWD who alive lonely in Federal republic of germany. Reliable figures are difficult to make up one's mind because the majority (well-nigh 60%) of community-domicile PWD in Germany is not formally diagnosed with dementia [9] and general practitioners (GP) are fifty-fifty less likely to recognize dementia when patients live solitary [10].
Even so, many PWD in Frg wish to remain at their own home as long every bit possible, even if they alive alone [11]. To provide adequate treatment and care co-ordinate to the individual needs of these PWD, health care and nursing intendance providers need to know more about this group of patients. The nowadays report aims to contribute empirical data on community-dwelling house PWD living alone in Federal republic of germany. Specifically, we want to determine (one) the prevalence of community-domicile PWD who live alone as well as the prevalence of PWD who live alone without the support of an informal caregiver and (2) socio-demographic and clinical characteristics as well as health care and nursing care utilization associated with living lone with and without the support of an breezy caregiver.
MATERIALS AND METHODS
Study design
The present cross-exclusive analyses are based on information derived from the GP-based, randomized controlled intervention trial DelpHi-MV (Dementia: Life- and person-centered assistance in Mecklenburg-Western Pomerania). The details of the study are described elsewhere [12–14]. The eligible patients (older than 70 years, living at home) were screened for dementia in participating GP practices using DemTect [15]. This personal interview-based instrument includes five tasks (recollect of word list, number transcoding task, give-and-take fluency chore, digit bridge opposite, delayed recall of word list) and is widely used for dementia screening in GP practices in Germany [sixteen]. All patients who had screened positive for dementia (DemTect-score <9) were informed by their GPs virtually the report, invited to participate, and asked to provide a written informed consent. If the patient named a caregiver, the caregiver was asked to participate in the study also. When the patients were unable to provide a written informed consent, their legal representatives were asked to sign the consent grade on their behalf (as approved past the Ethical Committee of the Sleeping room of Physicians of Mecklenburg-Western Pomerania, registry number BB 20/11). Report enrollment into the main written report started on Jan i, 2012 and concluded on December 31, 2014. The participants and their caregivers were assigned to an intervention grouping (received "Dementia Care Management") and a control group (received "intendance as usual"). In both groups, identical, standardized, computer-assisted baseline assessments were conducted every bit contiguous interview at the participants' homes.
Study sample
Figure i shows the flow of the study participants through each stage of the DelpHi-study.
Flow of the study participants through each stage of the DelpHi-report.
Of ane,167 eligible patients 634 (54.5%) provided informed consent. Of these, 516 patients were assessed at baseline. At that place were no statistically pregnant differences between patients assessed at baseline and those who dropped-out before the baseline-cess regarding the DemTect-score, historic period, and sexual practice (meet Supplementary Table 1). The present analyses are based on the data of 511 patients at 93 GP practices. Non all variables could be assessed completely in all subjects due to the amount of information assessed and the cognitive damage of the participants. Missing data were statistically significantly more than frequent among patients with more astringent cognitive impairment (according to the DemTect-score, see Supplementary Table 2). In the case of missing data the number of participants for the respective variable is provided in the Tables 1 and2.
Table i
Socio-demographic and clinical characteristics of the study sample
| Total sample (n = 511) | Living situation (n = 511) | Living alone (n = 260) | |||||
| Living with another person (n = 251) | Living alone (north = 260) | p-value | with breezy caregiver (n = 236) | without breezy caregiver (n = 24) | p-value | ||
| Sex (female), n (%) | 303 (59.iii) | 117 (46.half dozen) | 186 (71.5) | <0.001 a | 174 (73.7) | 12 (50.0) | 0.018 a |
| Age, mean (SD) | eighty.3 (v.v) | 79.1 (5.2) | 81.5 (5.6) | <0.001 b | 81.seven (5.5) | 79.8 (vi.3) | 0.172b |
| Marital status | |||||||
| Single, northward (%) | 29 (5.7) | 9 (3.6) | 20 (7.7) | <0.001 a | 14 (5.9) | 6 (25.0) | 0.010 a |
| Married, n (%) | 215 (42.i) | 187 (74.5) | 28 (x.8) | 27 (11.4) | 1 (4.ii) | ||
| Divorced, n (%) | 36 (7.1) | 6 (2.4) | 30 (11.5) | 26 (11.0) | four (16.7) | ||
| Widowed, north (%) | 231 (45.2) | 49 (19.5) | 182 (seventy.0) | 169 (71.6) | xiii (54.2) | ||
| Living in partnership (yeah), n (%) | 253 (49.5) | 210 (83.7) | 43 (16.5) | <0.001 a | 41 (17.four) | 2 (8.iii) | 0.388a |
| Number of children, mean (SD) | two.three (ane.vi) | 2.5 (1.5) | 2.2 (one.7) | 0.075b | 2.3 (1.7) | 1.two (ane.2) | <0.001 b |
| Back up of informal | 485 (94.9) | 249 (99.2) | 236 (90.8) | <0.001 a | – | – | – |
| caregiver (yeah), n (%) | |||||||
| Spouse/partner, north (%) | 193 (39.8) | 168 (67.five) | 25 (10.six) | <0.001 a | – | – | – |
| Girl/son, n (%) | 205 (42.three) | 63 (25.3) | 142 (lx.2) | ||||
| Daughter/son-in-law, northward (%) | 18 (three.vii) | iv (1.6) | 14 (5.9) | ||||
| Sister/brother, north (%) | xi (two.3) | 3 (1.2) | 8 (iii.4) | ||||
| Granddaughter/-son, northward (%) | ix (1.9) | two (0.8) | 7 (three.0) | ||||
| Others, n (%) | 49 (10.1) | 9 (iii.6) | 40 (17.0) | ||||
| Tin can somebody help | northward = 510 | n =251 | n =259 | n =235 | due north =24 | ||
| in case of emergency? | |||||||
| Yes, within 24 hours, n (%) | 453 (88.8) | 236 (94.0) | 217 (83.8) | <0.001 a | 210 (89.4) | 7 (29.ii) | <0.001 a |
| Yep, but non within 24 hours, n (%) | 38 (7.five) | 14 (5.6) | 24 (9.iii) | 21 (eight.9) | 3 (12.v) | ||
| Perceived social support (FSozu) | n = 479 | n =236 | n =243 | north =220 | n =23 | ||
| Score, mean (SD) | iv.0 (0.vii) | iv.1 (0.6) | 3.9 (0.vii) | <0.001 b | iii.9 (0.6) | iii.1 (1.0) | 0.001 b |
| Cerebral impairment (MMSE) | n = 468 | n =235 | n =233 | due north =212 | n =21 | ||
| Score, mean (SD) | 22.2 (five.iii) | 22.2 (5.6) | 22.2 (5.0) | 0.968b | 22.0 (five.0) | 23.ix (4.7) | 0.103b |
| No (score, 27–thirty), n (%) | 108 (23.1) | 56 (23.8) | 52 (22.three) | 0.926a | 44 (xx.8) | 8 (38.1) | 0.314a |
| Mild (score, 20–26), n (%) | 239 (51.ane) | 118 (50.ii) | 121 (51.9) | 111 (52.4) | ten (47.6) | ||
| Moderate (score, x–19), due north (%) | 107 (22.9) | 53 (22.5) | 54 (23.2) | 51 (24.i) | 3 (xiv.3) | ||
| Astringent (score, 0–9), n (%) | fourteen (iii.0) | eight (three.iv) | 6 (2.six) | 6 (2.eight) | – | ||
| Diagnosis of dementia (ICD-ten) | n = 510 | n =250 | due north =260 | n =236 | n =24 | ||
| Yes, n (%) | 194 (38.0) | 101 (twoscore.four) | 93 (35.eight) | 0.316a | 83 (35.2) | 10 (41.7) | 0.513a |
| Functional harm (B-ADL) | north = 498 | due north =245 | n =253 | n =230 | n =23 | ||
| Score, mean (SD) | 3.vii (2.vi) | iii.7 (two.seven) | three.7 (2.v) | 0.887b | 3.8 (2.5) | 2.7 (2.ii) | 0.028 b |
| Falls (in the by vi calendar month) | n = 507 | n =250 | northward =257 | n =233 | n =24 | ||
| Yeah, due north (%) | 143 (28.two) | 65 (26.0) | 78 (30.4) | 0.280a | 69 (29.6) | 9 (37.five) | 0.485a |
| Depression (GDS ≥six) | due north = 490 | n =240 | n =250 | n =226 | north =24 | ||
| Aye, n (%) | 76 (15.5) | 35 (14.half-dozen) | 41 (16.four) | 0.619a | 36 (15.ix) | 5 (20.8) | 0.562a |
| Drug-related issues (DRP) | n = 491 | n =244 | n =247 | n =226 | n =21 | ||
| Number of DRP, mean (SD) | 2.4 (i.5) | 2.four (1.v) | 2.4 (one.four) | 0.668b | 2.iv (1.4) | ii.4 (1.7) | 0.953b |
| Malnutrition (loss of weight | n = 500 | north =246 | north =254 | n =230 | n =24 | ||
| ≥5 kg in by iii month) | |||||||
| Yes, northward (%) | 62 (12.4) | 31 (12.6) | 31 (12.two) | 0.893a | 29 (12.6) | 2 (eight.3) | 0.748a |
| Quality of life (QoL-Advertisement) | due north = 493 | n =240 | n =253 | n =229 | n =24 | ||
| Score, hateful (SD) | two.eight (0.4) | 2.8 (0.three) | 2.8 (0.iv) | 0.263b | ii.8 (0.4) | ii.6 (0.half-dozen) | 0.272b |
FSozu, Social Support Questionnaire; mean score ane–v, college score indicates better social support; MMSE, Mini Mental State Examination, range 0–30; college score indicates amend cognitive functioning; B-ADL, Bayer Activities of Daily Living Calibration; range 0–10; lower score indicates ameliorate performance; GDS, Geriatric Depression Scale, sum score 0–fifteen; score ≥6 indicates low; QoL- Advertisement, Quality of life in Alzheimer'due south disease; hateful sum score i–four, higher score indicates better quality of life aFisher'southward exact test; bWelch'due south t-test. Bold p-values signal p < 0.05.
Table 2
Utilization of health care and nursing care services (in the past 12 months)
| Total sample (n = 511) | Living situation (northward = 511) | Living alone (north = 260) | |||||
| Living with another person (due north = 251) | Living alone (n = 260) | p-value | with informal caregiver (due north = 236) | without informal caregiver | p-value | ||
| Visit to GP, due north (%) | 511 (100.0) | 251 (100.0) | 260 (100.0) | – | 236 (100.0) | 24 (100.0) | – |
| Number of visits, mean (SD) | 7.0 (6.four) | 6.8 (half dozen.1) | vii.2 (six.half dozen) | 0.519b | 7.1 (vi.eight) | 8.0 (four.2) | 0.380b |
| Visit to neurologist/psychiatrist | northward =500 | n =246 | n =254 | n =231 | north =23 | ||
| Yes, northward (%) | 127 (25.iv) | 73 (29.7) | 54 (21.3) | 0.032 a | 49 (21.2) | v (21.vii) | >0.999a |
| Number of visits, mean (SD) | 0.8 (ii.9) | 0.nine (2.1) | 0.7 (3.4) | 0.333b | 0.7 (3.6) | 0.7 (1.4) | 0.988b |
| Hospital access | n =499 | n =248 | due north =251 | n =227 | north =24 | ||
| Yeah, n (%) | 141 (28.iii) | 82 (33.1) | 59 (23.5) | 0.022 a | 54 (23.8) | 5 (20.8) | >0.999a |
| Number of days in infirmary, | 4.0 (9.vi) | iv.8 (10.9) | 3.2 (8.1) | 0.058b | iii.4 (viii.4) | 1.6 (iii.ix) | 0.083b |
| hateful (SD) | |||||||
| Professional home intendance | north =508 | n =251 | n =257 | n =233 | n =24 | ||
| Yep, n (%) | 121 (23.eight) | 34 (13.6) | 87 (33.9) | <0.001 a | 75 (32.2) | 12 (50.0) | 0.111a |
| Number of contacts/ year, | 121.3 (289.0) | 59.half dozen (221.1) | 181. 5 (332.1) | <0.001 b | 161.five (304.one) | 374.8 (501.7) | 0.052b |
| hateful (SD) | |||||||
| Professional person mean solar day care | n =496 | due north =246 | northward =250 | n =226 | n =24 | ||
| Yes, north (%) | 21 (four.2) | 10 (4.1) | 11 (4.4) | >0.999a | 11 (4.ix) | – | 0.607a |
| Professional assist with medication | n =480 | north =242 | northward =238 | due north =219 | north =19 | ||
| Yes, north (%) | 106 (22.1) | 20 (8.3) | 86 (36.1) | <0.001 a | 78 (35.six) | 8 (42.1) | 0.622a |
| Professional housekeeping | n =508 | due north =251 | north =257 | n =233 | n =24 | ||
| assistance, n (%) | |||||||
| Aye, n (%) | 59 (11.6) | 22 (eight.8) | 37 (14.4) | 0.053a | 28 (12.0) | 9 (37.v) | 0.003 a |
| Home-delivered meals | n =508 | northward =251 | n =257 | n =233 | n =24 | ||
| Yes, north (%) | 99 (19.5) | 31 (12.4) | 68 (26.5) | <0.001 a | 63 (27.0) | v (20.8) | 0.631a |
aFisher's exact exam; bWelch's t-examination. Bold p-values point p < 0.05.
Procedures and instruments
For the description of socio-demographic and clinical characteristics of the report sample sex, age, marital status (unmarried, married, divorced, widowed), living in a partnership (yes/no), number of children, presence of an informal caregiver (yes/no), description of the informal caregiver (spouse/partner, girl/son, daughter/son-in-law, sister/blood brother, granddaughter/-son, others), availability of assistance in case of emergency (no/yep, within 24 h/yes, merely not within 24 h), formal diagnosis of dementia (aye/no), falls in the past six calendar month (yes/no), malnutrition (loss of body weight ≥5 kg over the past three months), number of drug-related problems (DRP), cognitive impairment, depression, functional impairment, quality of life, and the perceived social back up were analyzed.
The baseline assessment includes a comprehensive home medication assessment [17] to certificate all drugs used by the PWD including over-the-counter medicines. DRPs were classified according to the PI-Doc® coding arrangement [eighteen]. The principal DRP groups comprise unsuitable drug choice, unsuitable use by the patient (including compliance), unsuitable dosage, drug-drug interactions, adverse drug reactions, other drug-related problems, and patient-related/communication-related/technical and logistic problems. All identified DRPs were summed to the full number of DRPs per patient.
Cerebral damage was assessed using the German version of the Mini-Mental State Examination (MMSE) [19]. In the analyses nosotros used the full MMSE score as well as a categorization that indicates "no cerebral impairment" (score 27–30), "mild" (score 20–26), "moderate" (score 10–xix), and "severe cerebral harm" (score 0–9). Depression was operationalized using the score of the Geriatric Depression Scale (GDS) [twenty] equally dichotomized variable ("no depression": Score 0–five; "depression": Score vi–xv). The functional impairment was assessed using the Bayer Activities of Daily Living Scale (B-ADL) [21], which yields a mean score of one to 10, where ten indicates the highest possible impairment. The quality of life was assessed using the mean score of the Quality of Life-Advertisement (QoL-Advertizing) [22], a brief 13-item personal interview designed specifically to obtain a rating of the quality of life from PWD. The measure consists of thirteen items, rated on 4 point scales, with ane being poor and 4 beingness fantabulous. The perceived social support was assessed using the mean score of the 22-item version of the Social Support Questionnaire (FSozu) [23]. The FSozu is a self-report questionnaire to assess full general social support, covering iii central characteristics of social support (practical and textile support, emotional support, and social integration). Statements regarding perceived or predictable social back up are rated on a v-point Likert scale, ranging from ane (does not apply) to 5 (exactly applicative).
For all patients who had provided the respective informed consent, the formal medical diagnoses (ICD-10 codes: F00, F01, F02, F03, G30, and G31) were retrieved from the medical records in their GPs' practice (including the date of the initial diagnosis).
To describe the health care and nursing intendance utilization in the past 12 months, we analyzed the following variables: Consultation of the GP (yes/no) and number of visits, consultation of neurologist/psychiatrist (yes/no) and number of visits, hospital access (yes/no) and number of days in hospital, professional home care (yes/no) and number of visits in the past 12 months, attending professional twenty-four hour period care (yes/no), professional housekeeping assistance (yes/no), professional help with medication (aye/no), and home-delivered meals (yes/no). These variables were assessed in a standardized personal figurer-assisted interview which contained lists of common resources and services to select from in order to minimize the retrieve bias. For more precise information and to improve data quality, the participant's caregiver (if present) assisted in the interview. In instance of missing data, other bachelor proxies, such as documentation of nursing services, were used.
Statistical analyses
Variables that describe the sample were summarized using descriptive statistics. For univariate subgroup analyses, the patients were divided into the following groups: (1) patients living alone versus non living lone, and (2) patients living alone with versus without an breezy caregiver ("at that place is someone who could take intendance of me on a regular basis" yes/no). To examination for the differences betwixt subgroups we used Welch'southward t test (robust to unequal variances) for continuous and Fisher's exact test for categorized variables (significance level 5%). We conducted multivariate regression analyses to clarify the association of living lonely (predictor variable) with the following patient outcomes (dependent variables): Presence of informal caregiver, availability of help in case of emergency, self-perceived social back up, low, quality of life, drug-related issues, malnutrition, falls, formal diagnosis of dementia, visit to neurologist/psychiatrist, hospital access, utilization of professional dwelling house care, assist with medication, housekeeping help, and habitation-delivered meals. These analyses were performed unadjusted besides as adapted for potentially misreckoning variables (age, sexual activity, cognitive and functional impairment, living in partnership, presence of informal caregiver, depression, and visit of neurologist/ psychiatrist).
Considering the DelpHi-study is a cluster-randomized trial, the dependency of information from participants who belonged to the same cluster (i.e., the same treating GP) had to be considered. Therefore, we applied random furnishings logistic/generalized least foursquare (GLS) regression models, which can offering consistent estimates in cases of clustered data. Standard errors of the regression coefficients were estimated using the jackknife method for the logistic regression models and the bootstrapping procedure (ii,000 replications) for the linear regression models. The statistical analyses were performed using Stata/IC [24].
RESULTS
Socio-demographic and clinical characteristics of the report sample
Tabular array 1 (offset column) shows the socio-demo-graphic and clinical characteristic of the report sample.
Patients living alone
Approximately half of all chief care patients screened positive for dementia lived lone (50.nine%). Tabular array 1 presents the differences in socio-demographic and clinical characteristics between patients who lived solitary and those who lived together with another person.
The socio-demographic characteristics differed considerably betwixt these two groups: Patients who lived lonely were statistically significantly more often female (71.v versus 46.6%; p < 0.001), older (mean age (SD): 81.5 (5.6) versus 79.1 (5.ii) years; p < 0.001), less often married (ten.eight versus 74.5%; p < 0.001), and more than often widowed (70.0 versus 19.v%; p < 0.001). Only xvi.five% of the patients who lived alone had a partner, in contrast to 83.7% of the patients who did not alive lonely (p < 0.001). More than 90% of the patients living solitary were supported past an breezy caregiver. Almost two-thirds of these breezy caregivers were children or grandchildren of these patients. The vast majority of the patients living solitary had somebody who could assistance them in the case of an emergency (93.1%). The self-perceived social support was significantly lower in patients living alone (mean FSozu-score (SD): three.9 (0.7) versus iv.1 (0.half-dozen); p < 0.001).
Regarding the clinical variables (cerebral and functional impairment, depression, falls, number of drug related problems, malnutrition, quality of life), at that place were no statistically significant group differences.
Table two shows the utilization of health and nursing care services. Overall, patients living lone utilized more oft professional services such as dwelling care (33.9 versus xiii.6%; p = 0.022), assistance with medication (36.1versus 8.3%; p < 0.001), dwelling house-delivered meals (26.5 versus 12.four%; p < 0.001), or professional housekeeping assistance (14.4 versus 8.8%; p = 0.053). In contrast, patients living alone utilized certain wellness care services statistically significantly less often (visit to neurologist/psychiatrist: 21.3 versus 29.vii%; p = 0.032; hospital admission: 23.5 versus 33.one%; p < 0.022).
Patient outcomes associated with living alone
Farther multivariate regression analyses were performed to analyze the association of living lone (predictor variable) with dissimilar patient outcomes (unadjusted as well equally adjusted for potential confounders). The results of these analyses are summarized in Table 3. The results showed that living alone was statistically significant associated with a lower chance for the presences of an breezy caregiver (OR = 0.91, p < 0.001; 95% CI 0.06–0.fourteen), the availability of help in the case of an emergency (OR = 0.26, p < 0.001; 95% CI 0.13–0.50), and with lower cocky-perceived social back up (regression coefficient (RC) = –0.19, p = 0.022; 95% CI 0.35–0.03). On the other mitt living alone was statistically pregnant associated with a college gamble for the utilization of professional dwelling care (OR = 3.62, p < 0.001; 95% CI 1.86–7.04), help with medication (OR = vii.17, p < 0.001; 2.80–18.39), and dwelling house-delivered meals (OR = 2.55, p = 0.004; 95% 1.37–4.76).
Table iii
Patient outcomes associated with living solitary (each line represents a split regression analyses; unadjusted and adjusted for the respective covariates)
| Dependent variable in regression analyses | Unadjusted | Adjusted | ||||||||
| OR/RC | t/z | p | 95% CI | OR/RC | t/z | p | 95% CI | |||
| Presence of informal caregiver (yes)i | 0.04 | 12.35 | <0.001 | 0.03 | 0.07 | 0.91 | 12.08 | <0.001 | 0.06 | 0.14 |
| Help in instance of emergency (yes)2 | 0.06 | vii.13 | <0.001 | 0.03 | 0.14 | 0.26 | 4.09 | <0.001 | 0.thirteen | 0.50 |
| Perceived social support (FSozu)3 | –0.25 | 2.84 | 0.004 | –0.42 | –0.08 | –0.19 | 2.28 | 0.022 | 0.35 | 0.03 |
| Depression (GDS ≥half-dozen)four | i.xvi | 0.47 | 0.641 | 0.63 | 2.xiii | 0.85 | 0.46 | 0.648 | 0.42 | 1.72 |
| Quality of life (QoL-Advert)5 | –0.05 | 1.22 | 0.222 | –0.12 | 0.03 | 0.03 | 0.72 | 0.472 | –0.06 | 0.12 |
| Drug-related problemssix | –0.05 | i.23 | 0.218 | –0.12 | 0.03 | –0.14 | 0.72 | 0.469 | –0.l | 0.23 |
| Malnutrition7 | 0.88 | 0.45 | 0.654 | 0.50 | ane.54 | 0.85 | 0.53 | 0.594 | 0.46 | i.56 |
| Falls8 | i.33 | 1.37 | 0.173 | 0.88 | 1.99 | 0.79 | 0.90 | 0.369 | 0.46 | 1.34 |
| Diagnosis of dementianine | 0.77 | 1.23 | 0.223 | 0.l | 1.eighteen | 0.79 | 0.90 | 0.369 | 0.46 | 1.34 |
| Visit to neurologist/psychiatrist (yes)10 | 0.70 | 1.36 | 0.177 | 0.42 | one.18 | 0.99 | 0.02 | 0.980 | 0.56 | 1.77 |
| Infirmary admission (aye)11 | 0.61 | two.16 | 0.034 | 0.38 | 0.96 | 0.67 | 1.53 | 0.130 | 0.39 | 1.13 |
| Professional person abode care (yeah)12 | 3.68 | iv.45 | <0.001 | 2.06 | 6.58 | 3.62 | 3.83 | <0.001 | 1.86 | 7.04 |
| Professional person help with medication (yes)13 | 7.52 | iv.71 | <0.001 | 3.21 | 17.63 | 7.17 | 4.16 | <0.001 | two.80 | 18.39 |
| Professional housekeeping assistance (yes)xiv | 2.10 | 2.01 | 0.048 | 1.01 | 4.37 | 1.39 | 0.82 | 0.412 | 0.63 | iii.xi |
| Home-delivered meals (yes)15 | 2.77 | 3.17 | 0.002 | 1.46 | 5.25 | 2.55 | two.99 | 0.004 | 1.37 | 4.76 |
Random furnishings logistic/generalized to the lowest degree squares (GLS) regression analyses, OR, odds ratio; RC, regression coefficient; CI, confidence interval; FSozu, Social Back up Questionnaire; mean score ane–5; college score indicates ameliorate social support; MMSE, Mini Mental State Exam; range 0–30; higher score indicates better cognitive functioning; B-ADL, Bayer Activities of Daily Living Scale; range 0–10; lower score indicates ameliorate performance; GDS, Geriatric Low Calibration, sum score 0–15; score ≥6 indicates low; QoL- AD, Quality of life in Alzheimer's disease; mean sum score ane–four, higher score indicates better quality of life. 1459 observations; 90 cluster: F(6,88) = 37.15, p < 0.001 (adjusted for age, sexual activity, cognitive/functional impairment, living in partnership); 2458 observations; 90 cluster: F(6,88) = 17.86, p < 0.001 (adjusted for age, sex, cerebral/functional damage, living in partnership); three436 observations; 90 cluster: Wald chitwo (7) = 46.47, p < 0.001 (adjusted for age, sex activity, cognitive/functional impairment, depression, presence of informal caregiver); 4450 observations; xc cluster: F(6,89) = five.41, p < 0.001 (adapted for age, sex, cognitive/functional harm, presence of informal caregiver); 5451 observations; 90 cluster: Wald chi2 (vi) = 56.85, p < 0.001 (adjusted for age, sex activity, cognitive/functional impairment, presence of informal caregiver); half-dozen458 observations; ninety cluster: Wald chi2 (6) = 8.73, p = 0.190 (adjusted for historic period, sexual practice, cerebral/functional harm, presence of breezy caregiver); 7443 observations; 90 cluster: F(7,89) = 2.89, p = 0.009 (adapted for historic period, sexual activity, cerebral/functional harm, depression, presence of breezy caregiver); 8456 observations; ninety cluster: F(5,89) = eight.45, p < 0.001 (adjusted for historic period, sex activity, cognitive/functional impairment); nine440 observations; 90 cluster: F(7,89) = 5.78, p < 0.001 (adjusted for age, sex, cognitive/functional impairment, low, visit to neurologist/psychiatrist); 10441 observations; 90 cluster: F(7,89) = 5.43, p < 0.001 (adjusted for age, sex, cognitive/functional impairment, depression, presence of informal caregiver); xi441 observations; 90 cluster: F(7,89) = two.54, p = 0.020 (adjusted for historic period, sexual practice, cognitive/functional impairment, depression, presence of breezy caregiver); 12447 observations; 90 cluster: F(7,89) = 9.43, p < 0.001 (adjusted for historic period, sexual activity, cerebral/functional damage, depression, presence of informal caregiver); xiii443 observations; 87 cluster: F (7,86) = 5.37, p < 0.001 (adapted for historic period, sex, cognitive/functional damage, low, presence of breezy caregiver); 14456 observations; 90 cluster: F (6,89) = 12.03, p < 0.001 (adjusted for historic period, sex, cognitive/functional impairment, presence of breezy caregiver); 15447 observations; xc cluster: F (7,89) = 5.30, p < 0.001 (adjusted for historic period, sex activity, cognitive/functional impairment, depression, presence of breezy caregiver). Bold p-values indicate p < 0.05.
Patients living alone without the support of an informal caregiver
About 9% (n = 24) of the patients lived lone without the support of an breezy caregiver. The socio-demographic characteristics of these patients differed noticeably from the patients living alone who stated that they had an informal caregiver (see Tabular array i). Patients without an informal caregiver were statistically significantly more likely to be male (50.0 versus 26.iii%; p = 0.018), they were more than often unmarried (25.0 versus v.nine%), and less ofttimes widowed (54.2 versus 71.6%) or divorced (1.7 versus 11.0%; p = 0.010) equally compared to patients with an informal caregiver. They had fewer children (hateful score (SD): one.2 (one.2) versus 2.3 (1.vii); p < 0.001), and had less ofttimes somebody who could help them in a case of emergency (41.7 versus 98.3%; p = 0.001).
The cocky-perceived social support was significantly lower in patients without an informal caregiver (mean FSozu-score (SD): 3.i (i.0) versus 3.9 (0.6); p < 0.001).
Regarding the clinical variables there was only one statistically pregnant difference between both groups: Patients without an breezy caregiver were less dumb in their activities of daily living (mean B-ADL- score (SD): 2.7 (2.2) versus iii.8 (two.5); p = 0.028).
The utilization of health intendance and nursing intendance services is shown in Table two. Patients without an breezy caregiver utilized more often professional services such every bit habitation care (fifty.0 versus 32.ii%; not pregnant), help with medication (42.1 versus 35.6%; not significant), or housekeeping assist (37.5 versus 12.0%; p = 0.003). Regarding the utilization of health intendance services there were no statistically significant differences between both groups.
DISCUSSION
This is the outset study that provides empirical data on the proportion and characteristics of German language master care patients screened positive for dementia who alive lonely. The analyses revealed that approximately half of all customs-dwelling patients with dementia lived alone, and nigh 9% of them were non supported by an informal caregiver. For the United states, it is estimated that about 15–35% of PWD live lone and upward to half of PWD have no identifiable caregiver [3]. Compared to the United states, the proportion of PWD who live alone was higher, only the per centum of patients without an informal caregiver was noticeably lower in our German sample. One reason for this difference might exist the fact that well-nigh studies on PWD include only patients who are formally diagnosed with dementia, thus omitting about 50–lxxx% of PWD without a formal diagnosis of dementia from the analyses [25]. In the present sample, 62% of PWD were non formally diagnosed with dementia by their GP.
Non surprisingly, the socio–demographic characteristics of PWD who lived alone differed considerably from those patients who lived together with another person. Overall, PWD living solitary tended to be older and more often female. The majority of these patients were widowed (70%), implying that a major reason for living alone was the expiry of the patients' spouse. These findings are in line with the results of previous studies [3, five–7]. Surprisingly, regarding the clinical variables examined we did not discover any statistically significant differences between PWD who lived alone and those who did not. PWD living alone were neither cognitively nor functionally less impaired. In addition, our data indicate that PWD living alone did non seem to have more wellness risks—they did not differ from those not living solitary regarding low, quality of life, falls, drug related issues, or malnutrition. Thus, our findings do not agree with the results of onetime studies that showed that PWD living alone are less cognitively and functionally impaired, and at the same time are at a higher take a chance for health problems [3, 5–7]. A possible caption for these discrepancies could be differences in the study samples. The participants of this study were on average less cognitively impaired than the participants in comparative studies. In add-on, merely 38% of the positively screened patients had been formally diagnosed with dementia by their GP, and but 25% of the patients underwent a visit to a neurologist or psychiatrist. Thus, the proportion of patients who lacked a (specialist) diagnosis was relatively high. Some report participants might have been cognitively impaired due to other causes than dementia (due east.g., depression or vitamin B12-deficiency). This could accept skewed the results. Notwithstanding, the present diagnosis charge per unit is comparable to international rates in the primary care setting (xx–50%) [25].
To enable PWD to remain safely at home as long as they wish, they need access to acceptable medical treatment and professional in-home care services. A major reason for the present study outcomes regarding the clinical variables could exist that patients living alone were utilizing more often professional health care and nursing care services such as home care or help with medication. The utilization of such professional person services might substitute the back up past an informal caregiver who lives in the aforementioned household. Univariate analyses showed that the utilization of certain health care services (due east.g., specialist medico; hospital) was negatively associated with living alone. However, multivariate analyses that were adjusted for confounding variables did non confirm these associations. Our findings are in line with previous studies that showed that PWD living alone apply wellness care offers less frequently, but professional services more than oft than PWD who are not living alone [3, 6, 7]. A possible reason for the differences in the study outcomes regarding clinical variables could be that German language PWD living alone may have better access to professional services than PWD in countries like the Us. The utilization of such services is generally covered by wellness and nursing intendance insurances that are mandatory for every German citizen. Thus, the utilization of such services is largely contained of the individual financial condition of the patients.
More than than 90% of the patients who lived alone were supported by an breezy caregiver, mostly their child or grandchild. However, at that place was a modest group of patients (well-nigh nine%) who lived lone without having whatever breezy caregiver. Only 29% of these patients had somebody who could assistance them within 24 hours in the example of an emergency. This lack of breezy support can put these patients at special risks in the instance of a personal or health crisis; nether such circumstances, there is a loftier probability that these patients have to move to a nursing home rashly and unplanned.
The socio-demographic characteristics differed considerably between the PWD who lived lone with and without an informal caregiver. Patients who were not supported by an informal caregiver tended to exist more oft male, unmarried, and they had a lesser number of children. One might assume that these patients did already live alone for a longer menstruum of time; they might be used to manage their everyday life on their own. Regarding the clinical variables there were no statistically significant group differences with the exception that patients who had no caregiver were less functionally dumb. Although the descriptive data indicated that patients without an informal caregiver did utilize professional services more than often, there were no statistically meaning differences between both groups autonomously from professional housekeeping assistance. Withal, because the group of patients without an breezy caregiver was small, the statistical ability might not have been sufficient to detect significant differences.
Compared to PWD who lived together with another person, the self-perceived social back up was significantly lower in patients living alone, specially in those who had no informal caregiver. Therefore, these patients should get meliorate admission to social activities and social support. In order to ensure social participation, patients should be encouraged and enabled to visit day care facilities more frequently. Our results showed that these institutions were used by merely four-5% of the study participants, with no departure betwixt the groups.
Then everything is fine, no need for action? Probably not. Previous analyses of our data showed that community-dwelling PWD had on average about nine unmet needs that should exist addressed, and there were no significant differences in the number of unmet needs betwixt patients who lived lone and those who did not [26]. Other studies demonstrated that PWD who lived alone had even more unmet needs than those living together with some other person [4, eight]. PWD who live alone, particularly if they have no breezy caregiver, may require special support in society to proceeds access to the treatment and care services that address their individual needs comprehensively. New care concepts for PWD such equally the Dementia Care Management (DCM) tested inside the present Delphi-trial aim to integrate multi-professional and multimodal strategies to optimize the individual handling and intendance of PWD within the framework of the established health care and social service system in close cooperation with the treating GP [12, xiii]. Nonetheless, dementia is a progressing illness and at a certain point it is hardly possible to go on to live safely lonely. Thus, it is of import to find the appropriate time and means to arrange the transition to formal care, e.g. in a nursing home. This process could be supported by a DCM.
Further analyses of our data volition enable us to determine prospective associations of living alone with relevant patient outcomes as well as the utilization of wellness and nursing intendance services. In add-on, we can determine to what extent unmet needs of PWD tin be addressed in the course of the Dementia Intendance Management and what touch the intervention will have on clinical patient outcomes and resource utilization.
Limitations and generalizability of results
The analyses are based on data that were mainly cocky-reported by patients with dementia. This might have reduced the validity and reliability of the assessment, specially among more severely cognitively dumb patients. In addition, the baseline cess was very enervating for cognitively dumb patients, thus not all variables could be assessed completely in all subjects, resulting in missing data. Missing data occurred more than frequently amid more severely cognitively impaired patients, thus these patients were underrepresented in the analysis. However, the effect was quite similar in PWD living alone and those who were not (come across Supplementary Table two).
In the context of the DelpHi-trial, 17.ane% of 6,838 community dwelling primary care patients (≥70 years) had screened positive for dementia. A previous study in Seattle (US) plant comparable prevalence rates among primary care patients aged 65 years or older (xviii%) [27]. In a population-based study sample of older adults in Leipzig (Germany) anile 75 or older, the prevalence of dementia according to the ICD-10 criteria was 12.iv% [28]. Of 1,167 eligible patients 54.4% could be enrolled into the study. This charge per unit is comparable with the charge per unit of a study on screening and diagnosis of dementia in Indianapolis (Us): 52.iii% of 434 positively screened patients aged 65 or older agreed to participate in the further study [29].
Fake-positive cases of dementia might have been included into the study sample. Twenty-three percentage of the primary care patients who had screened positive (DemTect-score <9) were not categorized as cognitively impaired according to their MMSE-score (27–xxx; assessed at baseline). A certain proportion of these patients might have been screened false-positive. Notwithstanding, previous studies showed that the MMSE is less sensitive for detecting milder forms of cerebral impairment than the DemTect [15, 30]. Thus the rate of simulated-positive screenings may be lower than 23%.
Overall, the representativeness of our information for primary care patients screened positive for dementia in the region of Mecklenburg Western-Pomerania (Germany) seems to be acceptable for patients with balmy to moderate cerebral damage.
Conclusions
The present study revealed the high proportion of PWD who live alone in Germany. Since the German society is rapidly aging, this figure will probably increase. In our study, PWD living alone did non seem to be at an increased adventure for their health, even if they lacked the support of an breezy caregiver. Our findings betoken that living lone with dementia is possible, even at more advanced stages of the disease. Probably these patients are able to recoup the lack of informal caregiver support past utilizing professional nursing care services more oft. In order to ensure the sufficient provision of wellness and nursing care services for PWD living alone, providers should consider the nowadays results for future planning.
Supplementary Textile
ACKNOWLEDGMENTS
The study is funded by the German Center for Neurodegenerative Diseases (DZNE) and the University Medicine Greifswald.
The DelpHi-trial was developed and established every bit a result of input from the following experts in their respective fields: Aniela Angelow, Grit Aßmann, Georgia Böwing, Thomas Fiß, Daniel Fredrich, Ingo Kilimann, Leonore Köhler, and Stefan Teipel. An experienced field written report team provided support with data collection and data management: Ines Abraham, Kerstin Albuerne, Vaska Böhmann, Kathleen Dittmer, Sarah Gardzella, Jana Hubert, Ulrike Kempe, Viktoria Kim-Boese, Julius Krause, Andrea Pooch, Saskia Moll, Melanie Reimann, Sabine Schmidt, and Christine Winckler. Nosotros thank all participating patients and their caregivers likewise as the participating general practitioners for their most valued collaboration.
Authors' disclosures bachelor online (http://j-alz.com/manuscript-disclosures/xv-1058r1).
Appendix
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927920/
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