Nursing homes are often thought of as a last resort, but sometimes a necessary one, for the care of people withdementia. The majority of people want to remain at home for as long as possible, and some may have even asked their family not to send them to a nursing home. One fear is they, (or a loved one) might decline, and eventually die, more quickly in a facility than he or she would at home. Is this accurate?
The short answer: It depends. The longer answer? There’s limited research on this question, but there are certain factors that make decline and death in dementia more likely to occur.
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Relevant Research
According to figures compiled in 2019, Alzheimer’s disease and related dementias are the 6th leading cause of death in the United States. So, where do people with dementia die?
One study published in theJournal of the American Geriatrics Societyinvolved more than 4,000 older adults who were studied for approximately five years. Researchers in this study tracked the deaths of the participants and found that almost half (46%) of those with dementia died at home, while 19% were at a nursing home and 35% were hospitalized when they died.
In contrast, a previous study published in 2005 found that 2/3 of deaths relating to dementia happened in a nursing home.
Decreased RiskHaving overweight and not losing weightReducing antipsychotic medications plus increased social interactionTreating behavioral and psychological symptoms of dementiaIncreased RiskDeliriumFalls and hip fracturesPressure soresUnable to perform activities of daily living (ADLs)PneumoniaAge 85 or older
Decreased RiskHaving overweight and not losing weightReducing antipsychotic medications plus increased social interactionTreating behavioral and psychological symptoms of dementia
Having overweight and not losing weight
Reducing antipsychotic medications plus increased social interaction
Treating behavioral and psychological symptoms of dementia
Increased RiskDeliriumFalls and hip fracturesPressure soresUnable to perform activities of daily living (ADLs)PneumoniaAge 85 or older
Delirium
Falls and hip fractures
Pressure sores
Unable to perform activities of daily living (ADLs)
Pneumonia
Age 85 or older
Factors Correlated With a Decreased Risk of Death in Dementia
While it’s difficult to find research that addresses where people with dementia will die more quickly, there are a few factors that have been correlated with a longer lifespan in dementia. They include the following:
Overweight
Ironically, while extra pounds in our middle-age years increases our risk of developing dementia, extra pounds in older people with dementia is associated with a reduced risk of death in nursing homes.
Weight loss in dementia, even in people living with obesity, should be viewed with concern because of this correlation with an increased risk of death.
Reducing Antipsychotic Medications Combined With Social Interaction Programs
There is a strong push to decrease the use of antipsychotic medications for people with dementia in nursing homes, and as a nation, we have made much progress in this area. However, some research says that’s not enough.It found that reducing the usage coupled with the provision of increased social interaction improved survival rates in facilities. Simply decreasing antipsychotic medications without adding other interventions resulted in an increase in thechallenging behaviors and emotionsrelated to dementia and did not improve survival rates.
Effective Treatment of Behavioral and Psychological Symptoms of Dementia
Another study of people with dementia living in nursing homes compared the mortality rates of people who receiving anti-depressant medications to those who were receiving antipsychotic medications.
Factors Associated With an Increased Risk of Death in Dementia
Conversely, research has associated these factors with a higher risk of dying for someone with dementia.
A Word from Verywell
Placing a loved one in a nursing care facility can be a difficult decision. Understanding which factors are correlated with positive and negative outcomes can be helpful in evaluating yourcare optionsas well as in developing realistic expectations.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Alzheimer’s Disease Fact Sheet. National Institutes of Health. May 2019.
Callahan CM, Arling G, Tu W, et al.Transitions in care for older adults with and without dementia. JAm Geriatr Soc. 2012;60(5):813-20. doi:10.1111/j.1532-5415.2012.03905.x
Cereda E, Pedrolli C, Zagami A, et al.Alzheimer’s disease and mortality in traditional long-term care facilities.Arch Gerontol Geriatr. 2013;56(3):437-41. doi:10.1016/j.archger.2012.12.001
Seitz DP, Gill SS, Gruneir A, et al.Effects of dementia on postoperative outcomes of older adults with hip fractures: a population-based study.J Am Med Dir Assoc. 2014;15(5):334-41. doi:10.1016/j.jamda.2013.12.011
Hicks KL, Rabins PV, Black BS.Predictors of mortality in nursing home residents with advanced dementia.Am J Alzheimers Dis Other Demen.2010;25(5):439-45. doi:10.1177/1533317510370955
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