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

Abstract

ObjectivesTo determine the long-term trajectories of health system use by persons with dementia as they remain in the community over time.DesignPopulation-based cohort study using health administrative data.SettingOntario, Canada from 1 April 2007 to 31 March 2014.Participants62 622 community-dwelling adults aged 65+ years with prevalent dementia on 1 April 2007 matched 1:1 to persons without dementia based on age, sex and comorbidity.Main outcome measuresRates of health service use, long-term care placement and mortality over time.ResultsAfter 7 years, 49.0% of persons with dementia had spent time in long-term care (6.8% without) and 64.5% had died (30.0% without). Persons with dementia were more likely than those without to use home care (rate ratio (RR) 3.02, 95% CI 2.93 to 3.11) and experience hospitalisations with a discharge delay (RR 2.36, 95% CI 2.30 to 2.42). As they remained in the community, persons with dementia used home care at a growing rate (10.7%, 95% CI 10.0 to 11.3 increase per year vs 6.7%, 95% CI 4.3 to 9.0 per year among those without), but rates of acute care hospitalisation remained constant (0.6%, 95% CI −0.6 to 1.9 increase per year).ConclusionsWhile persons with dementia used more health services than those without dementia over time, the rate of change in use differed by service type. These results, particularly enumerating the increased intensity of home care service use, add value to capacity planning initiatives where limited budgets require balancing services.

Examining the Concept of Healthcare Trajectories in Older Adults With Major Neurocognitive Disorder Using the ‘6W’ Multidimensional Model of Care Trajectories: A Mixed Methods Systematic Review Protocol

“…The degenerative nature of MNCD and the lack of effective treatments underscore the need for effective care planning. However, as the use of healthcare by people living with MNCD varies significantly throughout the disease process, ensuring access to timely and appropriate care represents a critical challenge (Bronskill et al, 2020).…”

“…Healthcare use by older adults with MNCD varies throughout the course of the disease. Their patterns of care use over time can be operationalized using the concept of healthcare trajectories, defined as the patterns of care use over time (Bronskill et al, 2020;Vanasse et al, 2018). A systematic review by Pinaire et al (2017) aimed to investigate how the concept of trajectory is defined, studied, and what it contributes, using myocardial infarction as a motivating example.…”

Impact of the COVID-19 Pandemic on Home Care Services Among Community-Dwelling Adults With Dementia

“…4,5 The disruption of health services can be particularly challenging for people living with dementia in the community, many of whom receive essential care from a variety of health care providers. 6 Individuals with dementia in Ontario access a variety of different publicly provided home care services, including personal care, nursing, and various professional services such as physiotherapy and occupational therapy. 7 Differences in the typical urgency of these services may have led to them being differentially affected by the pandemic.…”

Coronavirus Disease-2019 in Older People with Cognitive Impairment

“…The pandemic has often constrained or decreased the fragile balance of the organization of essential human care for maintaining patients at home. [17][18][19][20]…”