Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study

Abstract

To evaluate the trend of healthcare utilization among patients with dementia (PwD) in different post-diagnosis periods, Taiwan’s nationwide population database was used in this study. PwD were identified on the basis of dementia diagnoses during 2002–2011. We further subdivided the cases into 10 groups from the index year to the 10th year after diagnosis. The frequency of emergency department visits and hospitalizations, the length of stay, outpatient and department visits, and the number of medications used were retrieved. The Joinpoint regression approach was used to estimate the annual percent change (APC) of healthcare utilization. The overall trend of healthcare utilization increased with the progression of dementia, with a significant APC during the first to second year after diagnosis (p < 0.01), except that the frequency of outpatient visits showed a decreasing trend with a significant APC from the first to fifth year. All sex- and age-stratified analyses revealed that male gender and old age contributed to greater use of healthcare services but did not change the overall trend. This study provides a better understanding of medical resource utilization across the full spectrum of dementia, which can allow policymakers, physicians, and caregivers to devise better care plans for PwD.

Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels

“…The odds of long-term stay among people with dementia were considerably higher than people with other chronic conditions (Willink et al, 2016). The increase in nursing home use is associated with cognitive impairment and dementia progression due to challenges for families and caregivers, such as patients' escalating dependence on others, limitations of activities of daily living, and behavioral and psychiatric symptoms (Chen et al, 2021).…”

“…People with ADRD prefer to age in place and receive the care and treatments they need at home or in the location of their choice with comfort as long as possible (Wagner, 2021). However, evidence indicates that the emergency department admission and hospitalization rate increases as individuals' cognitive impairment progresses (Chen et al, 2021). Sociodemographic characteristics (e.g., education, race, and ethnicity) and health factors (e.g., cognitive impairment, limitations in activities of daily living, and the number of chronic conditions, collectively known as frailty) are associated with disparities in ACP and healthcare utilization and the type of healthcare settings used, such as home or hospital (Mah et al, 2021;Pereira et al, 2022;Rahemi, 2019;Rahemi et al, 2019;Rahemi & Williams, 2016Suntai et al, 2022).…”

“…People with ADRD prefer to age in place and receive the care and treatments they need at home or in the location of their choice with comfort as long as possible (Wagner, 2021). However, evidence indicates that the emergency department admission and hospitalization rate increases as individuals’ cognitive impairment progresses (Chen et al, 2021).…”

Effectiveness of a tablet‐based intervention for people living with dementia in primary care—A cluster randomized controlled trial

“…The burden of dementia is vast as it acts on individuals living with dementia (people living with dementia), their families and informal caregivers, the health care system, and society 1 . Healthcare service utilization and consequently health care costs represent a tremendous social and economic burden 4–6 . For example, a meta‐analysis from Germany found that, although healthcare costs for people living with dementia living at home are lower compared to the costs of people living with dementia who are institutionalized, higher total societal costs can be found among people living with dementia at home due to the higher informal care time 4 .…”

“…1 Healthcare service utilization and consequently health care costs represent a tremendous social and economic burden. [4][5][6] For example, a meta-analysis from Germany found that, although healthcare costs for people living with dementia living at home are lower compared to the costs of people living with dementia who are institutionalized, higher total societal costs can be found among people living with dementia at home due to the higher informal care time. 4 To address the dementia challenge, the World Health Organization (WHO) strongly recommends strengthening national dementia healthcare delivery.…”