Discussion
Findings, comparison with other studies
and interpretation
To our knowledge, this is the largest German study comparing
the prevalence of dementia according to place of
residence. We found that nursing home residents were
19-fold more likely to suffer from dementia than those
living in the community. Our estimate of 51.8 % dementia
patients in nursing home residents is quite the same as
published in the LEILA75? study (47.6 %) conducted in
1997/1998 [6] and a more recent survey from 2008/2009
(53.0 %) [3]. The finding that prevalences did not increase
in higher age groups is not supported by the LEILA75?
study [6]. Other German studies did not report age-specific
prevalences [3–5]. However, one has to keep in mind that
the highest age group in LEILA75? was 85? years [6].
When reported, most studies in nursing home residents
found that males were more often affected than females [5,
6].
In field studies, comparisons of prevalences between
persons living in nursing homes and community-dwelling
elderly are hampered by small sample sizes and the
inclusion of different age groups [6–8]. The BASE cohort
consists of persons aged 70 and older [8], the LEILA75?
included only those aged 75? years [6], and Fichter et al.
[7] drew a sample of persons aged 85 years and older.
When reported, nursing home residents are much more
affected by dementia than those living in the community
[6, 8]. This result was also found in our data.
Four German studies reported the prevalence of
dementia in the general population including both persons
living in nursing homes and community-dwelling older
adults [6–9]. The published health insurance analysis
included data as of 2002 [9]. All field studies used also
older data [6–8], and the most actual one (LEILA75?) was
conducted in 1997/1998 [6]. Although using a different
inclusion criteria, the analysis of a sample of 2.3 million
Table 2 Prevalence of
dementia stratified by place of
residence, age and sex
Nursing home residents (n = 4,584)
[95 % CI]
Community dwelling (n = 209,110)
[95 % CI]
Males Females Total Males Females Total
Age groups (in years)
65–69 35.7 %
[29.4–42.4]
40.9 %
[32.3–50.0]
37.6 %
[32.5–42.9]
0.8 %
[0.8–0.9]
0.7 %
[0.6–0.8]
0.8 %
[0.7–0.8]
70–74 46.4 %
[40.7–52.2]
44.0 %
[37.5–50.6]
45.4 %
[41.1–49.7]
1.8 %
[1.7–2.0]
1.7 %
[1.6–1.9]
1.8 %
[1.7–1.9]
75–79 51.8 %
[46.0–57.6]
49.2 %
[44.2–54.3]
50.4 %
[46.6–54.1]
4.0 %
[3.7–4.3]
3.8 %
[3.4–4.1]
3.9 %
[3.7–4.1]
80–84 48.2 %
[43.5–53.0]
57.0 %
[53.3-60.7]
53.6 %
[50.7–56.5]
7.1 %
[6.6–7.6]
7.2 %
[6.7–7.8]
7.2 %
[6.8–7.6]
85–89 57.0 %
[51.2–62.6]
57.1 %
[53.6–60.5]
57.1 %
[54.1–60.0]
10.6 %
[9.6–11.7]
11.4 %
[10.5–12.4]
11.1 %
[10.4–11.8]
90–94 54.8 %
[45.2–64.1]
53.7 %
[48.6–58.7]
54.0 %
[49.5–58.4]
14.6 %
[11.6–18.1]
19.2 %
[16.3–22.2]
17.3 %
[15.2–19.6]
95? 43.6 %
[27.8–60.4]
56.6 %
[49.2–63.8]
54.4 %
[47.7–61.0]
17.4 %
[10.1–27.1]
27.9 %
[22.0–34.4]
24.9 %
[20.1–30.2]
Region of
residence
East 55.5 %
[47.3–63.5]
61.8 %
[54.4–68.8]
58.9 %
[53.5–64.2]
2.2 %
[2.0–2.5]
2.2 %
[2.0–2.5]
2.2 %
[2.0–2.4]
West 48.1 %
[45.6–50.6]
53.1 %
[51.2–55.0]
51.3 %
[49.7–52.8]
2.6 %
[2.5–2.7]
3.0 %
[2.9–3.2]
2.8 %
[2.7–2.9]
Total 48.8 %
[46.4–51.1]
53.7 %
[51.9–55.6]
51.8 %
[50.4–53.3]
2.6 %
[2.5–2.6]
2.9 %
[2.8–3.0]
2.7 %
[2.6–2.8]
Aging Clin Exp Res (2014) 26:555–559 557
123
German insurants found quite comparable prevalences in
2002 to our estimates for 2009 [9]. Trends found in the
field studies for the general population [6–8] were also
visible in our community-dwelling elderly, even though the
prevalences in older age groups are comparably smaller in
our cohort.
Regional variations with higher prevalence in the Eastern
part of Germany in males and females above the age 85
were first described by Ziegler and Doblhammer [9]. We
also found higher prevalences in the East in nursing home
residents and in older age groups (data not shown).
Unfortunately, due to small sample sizes with only 341
nursing home residents living in East Germany, no further
regional analyses according to sex, age groups or federal
states were possible.
DiscussionFindings, comparison with other studiesand interpretationTo our knowledge, this is the largest German study comparingthe prevalence of dementia according to place ofresidence. We found that nursing home residents were19-fold more likely to suffer from dementia than thoseliving in the community. Our estimate of 51.8 % dementiapatients in nursing home residents is quite the same aspublished in the LEILA75? study (47.6 %) conducted in1997/1998 [6] and a more recent survey from 2008/2009(53.0 %) [3]. The finding that prevalences did not increasein higher age groups is not supported by the LEILA75?study [6]. Other German studies did not report age-specificprevalences [3–5]. However, one has to keep in mind thatthe highest age group in LEILA75? was 85? years [6].When reported, most studies in nursing home residentsfound that males were more often affected than females [5,6].In field studies, comparisons of prevalences betweenpersons living in nursing homes and community-dwellingelderly are hampered by small sample sizes and theinclusion of different age groups [6–8]. The BASE cohortconsists of persons aged 70 and older [8], the LEILA75?included only those aged 75? years [6], and Fichter et al.[7] drew a sample of persons aged 85 years and older.When reported, nursing home residents are much moreaffected by dementia than those living in the community[6, 8]. This result was also found in our data.Four German studies reported the prevalence ofdementia in the general population including both personsliving in nursing homes and community-dwelling olderadults [6–9]. The published health insurance analysisincluded data as of 2002 [9]. All field studies used alsoolder data [6–8], and the most actual one (LEILA75?) wasconducted in 1997/1998 [6]. Although using a differentinclusion criteria, the analysis of a sample of 2.3 millionTable 2 Prevalence ofdementia stratified by place ofresidence, age and sexNursing home residents (n = 4,584)[95 % CI]Community dwelling (n = 209,110)[95 % CI]Males Females Total Males Females TotalAge groups (in years)65–69 35.7 %[29.4–42.4]40.9 %[32.3–50.0]37.6 %[32.5–42.9]0.8 %[0.8–0.9]0.7 %[0.6–0.8]0.8 %[0.7–0.8]70–74 46.4 %[40.7–52.2]44.0 %[37.5–50.6]45.4 %[41.1–49.7]1.8 %[1.7–2.0]1.7 %[1.6–1.9]1.8 %[1.7–1.9]75–79 51.8 %[46.0–57.6]49.2 %[44.2–54.3]50.4 %[46.6–54.1]4.0 %[3.7–4.3]3.8 %[3.4–4.1]3.9 %[3.7–4.1]80–84 48.2 %[43.5–53.0]57.0 %[53.3-60.7]53.6 %[50.7–56.5]7.1 %[6.6–7.6]7.2 %[6.7–7.8]7.2 %[6.8–7.6]85–89 57.0 %[51.2–62.6]57.1 %[53.6–60.5]57.1 %[54.1–60.0]10.6 %[9.6–11.7]11.4 %[10.5–12.4]11.1 %[10.4–11.8]90–94 54.8 %[45.2–64.1]53.7 %[48.6–58.7]54.0 %[49.5–58.4]14.6 %[11.6–18.1]19.2 %[16.3–22.2]17.3 %[15.2–19.6]95? 43.6 %[27.8–60.4]56.6 %[49.2–63.8]54.4 %[47.7–61.0]17.4 %
[10.1–27.1]
27.9 %
[22.0–34.4]
24.9 %
[20.1–30.2]
Region of
residence
East 55.5 %
[47.3–63.5]
61.8 %
[54.4–68.8]
58.9 %
[53.5–64.2]
2.2 %
[2.0–2.5]
2.2 %
[2.0–2.5]
2.2 %
[2.0–2.4]
West 48.1 %
[45.6–50.6]
53.1 %
[51.2–55.0]
51.3 %
[49.7–52.8]
2.6 %
[2.5–2.7]
3.0 %
[2.9–3.2]
2.8 %
[2.7–2.9]
Total 48.8 %
[46.4–51.1]
53.7 %
[51.9–55.6]
51.8 %
[50.4–53.3]
2.6 %
[2.5–2.6]
2.9 %
[2.8–3.0]
2.7 %
[2.6–2.8]
Aging Clin Exp Res (2014) 26:555–559 557
123
German insurants found quite comparable prevalences in
2002 to our estimates for 2009 [9]. Trends found in the
field studies for the general population [6–8] were also
visible in our community-dwelling elderly, even though the
prevalences in older age groups are comparably smaller in
our cohort.
Regional variations with higher prevalence in the Eastern
part of Germany in males and females above the age 85
were first described by Ziegler and Doblhammer [9]. We
also found higher prevalences in the East in nursing home
residents and in older age groups (data not shown).
Unfortunately, due to small sample sizes with only 341
nursing home residents living in East Germany, no further
regional analyses according to sex, age groups or federal
states were possible.
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