The Impact of a Dementia Diagnosis

Image Credit: Adobe Stock Images/WSStudio1985.com

Perhaps it may come as no surprise, but history has shown that diseases have had an influence on human migration. The risk of infection when it comes to outbreaks—most recently including Ebola—has resulted in people relocating for a multitude of reasons, including improved access to healthcare.

There appears to be no record of a study that explores the connection between chronic disease incidence and migration. Having said that, one of the most prime examples of a rapidly growing one is dementia, whose global prevalence of dementia has been predicted to increase by 166% from 2019 to 2050.¹ In the United States specifically, the proportion of older adults that are passing away due to dementia has increased from 35% in 2004 to 47% in 2017.^2,3

Keeping this in mind, a cohort study published in JAMA Network Open⁴ sought to determine how a new dementia diagnosis impacts a patient’s migration patterns.

The study utilized a dataset of national Medicare claims and assessments spanning from 2012 to 2020, with the first four years being the pre-diagnosis period and the last four years being the post-diagnosis period. The dataset also featured Medicare Beneficiary Summary File and nursing home administrative datasets. The study focused on beneficiaries who received dementia, myocardial infarction, chronic obstructive pulmonary disease, or colon cancer diagnoses in 2016, as they wanted to address changes around the four-year mark. These analyses were conducted from March 2023 to August 2024.

The sample consisted of 1,626,127 Medicare beneficiaries (mean [SD] age, 80.1 [8.0] years; 922,194 women [56.7%]) who received diagnoses of the four conditions in 2016. A total 818,862 individuals had a new dementia diagnosis (age, 82.0 [7.8] years; 492,146 women [60.1%]). Comparing between the pre-diagnosis and post-diagnosis months, the proportion migrating to a different county increased by 8.5 percentage points (95% confidence interview, CI, 7.6-9.4 percentage points) for beneficiaries with dementia and between 4.2 to 5.8 percentage points among those with myocardial infarction, chronic obstructive pulmonary disease, or colon cancer.

The difference-in-difference estimates showed a 3.9 percentage point (95% CI, 3.7-4.0 percentage points) increase in intercounty migration and a 1.9 percentage point (95% CI, 1.8-2.0 percentage points) rise in interstate migration for patients with dementia, essentially doubling the likelihood of migration compared with the other conditions. Out of the additional migrations that were due to a dementia diagnosis, 55% occurred in community settings, while 45% occurred in an institutional environment.

According to the study investigators, “Our findings illuminate the profound impact that a dementia diagnosis can have on an individual’s residential choices, challenging traditional conceptions of aging in place and adding depth to our understanding of the interplay between health and migration. As the global population ages and dementia prevalence increases, it becomes crucial for policymakers and communities to recognize and address the unique migration patterns and needs of individuals with this life-altering condition.”

References

1. Global Burden of Disease 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105-e125. doi:10.1016/S2468-2667(21)00249-8PubMedGoogle ScholarCrossref

2. Rahman M, White EM, Mills C, Thomas KS, Jutkowitz E. Rural-urban differences in diagnostic incidence and prevalence of Alzheimer’s disease and related dementias. Alzheimers Dement. 2021;17(7):1213-1230. doi:10.1002/alz.12285PubMedGoogle ScholarCrossref

3. Davis MA, Chang CH, Simonton S, Bynum JPW. Trends in US Medicare decedents’ diagnosis of dementia from 2004 to 2017.JAMA Health Forum. 2022;3(4):e220346. doi:10.1001/jamahealthforum.2022.0346

4. Rahman M, Thapa BB, Santostefano C, et al. Patterns of Migration Following Dementia Diagnosis. JAMA Netw Open. 2024;7(10):e2439499. doi:10.1001/jamanetworkopen.2024.39499