PhD defence G.G. (Gaia) Bagnasco

Below is a brief summary of the dissertation:

Dementia gradually affects cognitive and physical functioning and impacts not only the patient, but also their immediate environment, such as family. Population aging is driving a sharp rise in the number of people with dementia, both in the Netherlands and worldwide, while curative treatments remain unavailable. This dissertation examines the social and economic consequences of dementia across three life domains — work, housing, and care — taking into account the heterogeneity in the dementia population.

Regarding work, individuals who develop dementia before age 65 show a gradual decline in labour force participation starting as early as 21 years before diagnosis. Those who leave work typically rely on disability benefits, though income loss is only partially compensated; people with lower education and those without a partner experience the greatest losses.

Regarding housing, most older adults with a long-term care eligibility assessment eventually move to a nursing home. Housing or neighbourhood characteristics do not appear to play a significant role in delaying this admission at this advanced disease stage; instead, higher age, male gender, and poorer health with comorbidities are associated with earlier admission. Caregivers living with the person with dementia report the highest burden, while assistive devices — particularly those aimed at risk prevention — are associated with reduced burden.

Regarding care, dependence on formal care increases toward the end of life, with distinct trajectories in the timing of home care and nursing home admission. People with higher income, home ownership, a partner, and better health tend to remain at home longer without formal care.