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

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.