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. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.