Dementia prevalence in Southern Switzerland across community‐dwelling and institutionalised older adults – the SwissDEM study
Deborah Pacifico, Anna Maria Annoni, Maddalena Fiordelli, Anja Frei, Gwendolyn Graf, Milo Puhan, Emiliano Albanese- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
Epidemiological evidence on dementia prevalence is outdated and still limited, and recent estimates (including those from the Institute for Health Metrics and Evaluation, IHME) may be an underestimation. Moreover, the recent WHO blueprint exercise confirmed that the quality of data we have is poor and based on weak and non‐standardized or even flawed methods. Dementia prevalence in nursing homes (NH) is likely high but evidence is scarce. We aimed to explore dementia and compare dementia prevalence in Southern Switzerland in community and in NH settings, using standardized and previously validated procedures and assessments.
Method
We conducted a cross‐sectional study among a random sample of community dweller older adults and a convenience sample of NH residents in the Canton of Ticino. Participants were dyads formed by an older adult (≥65 years old) and an informant. We collected socio‐demographic data and assessed cognitive function using the electronic version of the 10/66 short Dementia Diagnostic Schedule, which comprises the Community Screening Instrument for Dementia (CSI‐D), the CERAD animal verbal fluency and ten‐word list learning tasks, and the EURO‐Depression scale (EURO‐D). We performed descriptives, t‐tests, and chi‐square tests.
Result
We recruited 462 participants between June 2021 and August 2022. Participants living in the community (N = 300) had a mean age of 76.11 (SD = 6.46), and those living in NH (N = 162) of 87.62 (SD = 6.44). The prevalence of dementia was 6.3% (CI: 3.56‐9.11) in the community, and 75% (CI: 68.6‐82.02) in NH. Overall, dementia caseness was positively associated with age (p‐value <0.001), being a woman (p‐value < 0.001), and lower educational level (p‐value <0.001). However, these associations were not significant in the NH subsample (all p‐values >0.05). Among community‐dwelling older adults, dementia caseness was associated with age (p‐value <0.001), but not with gender, and education (all p‐values >0.05).
Conclusion
Our study shows the marked differences in dementia prevalence between community and NH settings, expanding recent models from the IHME. It is crucial to include institutionalised older adults when measuring dementia prevalence in populations, particularly in high‐income countries, and where people with dementia are more likely to and can live in NH.