Who Is Providing the Predominant Care for Older Adults With Dementia?

J Am Med Dir Assoc. 2016 Sep 1;17(9):802-6. doi: 10.1016/j.jamda.2016.04.026. Epub 2016 Jun 11.


Objectives: To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings.

Design: Cross-sectional analysis.

Participants: Fee-for-service Medicare beneficiaries aged ≥65 years with dementia.

Measurements: Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits.

Results: Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (P < .001).

Conclusion: It is unknown whether specialists are aware of their central role for many dementia patients' care needs. In LTC, NPs play the lead role as PPCs.

Keywords: Medicare; Predominant provider; dementia; long-term care; primary care; specialist.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Dementia*
  • Female
  • Humans
  • Long-Term Care
  • Male
  • Medicare
  • Nursing Homes*
  • Primary Health Care
  • Specialization*
  • United States