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

Abstract 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.