Joint impact of dementia and frailty on healthcare utilisation and outcomes: a retrospective cohort study of long-stay home care recipients

Abstract

ObjectivesTo examine the associations between dementia and 1-year health outcomes (urgent hospitalisation, long-term care (LTC) admission, mortality) among long-stay home care recipients and the extent to which these associations vary by clients’ frailty level.DesignA retrospective cohort study using linked clinical and health administrative databases.SettingHome care in Ontario, Canada.ParticipantsLong-stay (≥60 days) care clients (n=153 125) aged ≥50 years assessed between April 2014 and March 2015.Main outcome measuresDementia was ascertained with a validated administrative data algorithm and frailty with a 66-item frailty index (FI) based on a previously validated FI derived from the clinical assessment. We examined associations between dementia, FI and their interactions, with 1-year outcomes using multivariable Fine-Gray competing risk (urgent hospitalisation and LTC admission) and Cox proportional hazards (mortality) models.ResultsClients with dementia (vs without) were older (mean±SD, 83.3±7.9 vs 78.9±11.3 years, p<0.001) and more likely to be frail (30.3% vs 24.2%, p<0.001). In models adjusted for FI (as a continuous variable) and other confounders, clients with dementia showed a lower incidence of urgent hospitalisation (adjusted subdistribution HR (sHR)=0.84, 95% CI: 0.83 to 0.86) and mortality rate (adjusted HR=0.87, 95% CI: 0.84 to 0.89) but higher incidence of LTC admission (adjusted sHR=2.60, 95% CI: 2.53 to 2.67). The impact of dementia on LTC admission and mortality was significantly modified by clients’ FI (p<0.001 interaction terms), showing a lower magnitude of association (ie, attenuated positive (for LTC admission) and negative (for mortality) association) with increasing frailty.ConclusionsThe strength of associations between dementia and LTC admission and death (but not urgent hospitalisation) among home care recipients was significantly modified by their frailty status. Understanding the public health impact of dementia requires consideration of frailty levels among older populations, including those with and without dementia and varying degrees of multimorbidity.

Trajectories of health system use and survival for community-dwelling persons with dementia: a cohort study

“…Differences observed between dementia populations and those without dementia are likely attributable to differences in dementia severity as well as other important risk factors such as frailty. 27–29 While other studies have demonstrated similar rates of mortality in dementia and non-dementia populations, 11 30 the differences in mortality in our study suggest unmeasured differences in baseline health characteristics beyond age, sex and comorbidities.…”

Dementia increases mortality beyond effects of comorbid conditions: A national registry‐based cohort study

“…First, there may be an association between frailty, dementia, and mortality. Frailty, identified as a risk factor for developing dementia [30], has also been associated with increased risk of mortality in people with dementia [31,32]. Furthermore, an autopsy study by Wallace et al [33] reported that people with less frailty were less people who were more frail were more likely to express both neuropathological changes and clinical dementia symptoms.…”

“…First, there may be an association between frailty, dementia, and mortality. Frailty, identified as a risk factor for developing dementia [30], has also been associated with increased risk of mortality in people with dementia [31,32]. Furthermore, an autopsy study by Wallace et al [33] reported that people with less frailty were less tor for Alzheimer's dementia.…”

Derivation and validation of a 90-day unplanned hospital readmission score in older patients discharged form a geriatric ward

“…Dementia or a history of neurological disorders has previously been reported by other authors as being associated with early or late UHR after surgery [8,13,15,19]. Some studies have suggested that patients with dementia have an increased rate of frailty and urgent hospitalization [20][21][22]. It is possible that patients with cognitive or neurological disorders are more likely to decompensate for a chronic condition or represent an acute condition following an initial acute event.…”