Use of medical services by older Australian women with dementia: a longitudinal cohort study

Abstract

Objective: To assess the use of Medicare-subsidised health services by women with and without dementia.Methods: Data from women of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models.Results: A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non-emergency GP attendances (short [<30 minutes] IRR=1.11 [1.07, 1.13]; long [>30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. Conclusions:The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health:There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).

Do health assessments affect time to permanent residential aged care admission for older women with and without dementia?

“…There is also the potential that having a health assessment increased the chances of the person being identified with dementia; however, previous research found no association between these two. 15 It seems likely that any benefits accruing from health assessments will be dependent on the recency of the assessment (seen here) and repeated assessment (seen in other studies 7 ). According to Medicare policy, assessments can occur every year.…”

“…Owing to the long time between the beginning of dementia symptoms and a diagnosis, 19 many women may have had dementia well before this date, and many women with dementia may not have been diagnosed by a doctor or have had this diagnosis recorded in the administrative data. There is also the potential that having a health assessment increased the chances of the person being identified with dementia; however, previous research found no association between these two 15 …”

“…Measures used in the logistic regression propensity score calculation were age, SF36 general health, mental health and physical functioning scores, number of GP attendances, falls, concession card status, self‐reported general health, area of residence, partnered status, highest qualification, ability to manage on available income, and number of chronic diseases. Measures chosen were informed by previous research on the uptake of health assessments amongst this cohort of women 3,4,15 . Multiple imputation using fully conditional specification 26 with 25 imputations was used to account for missing data.…”

“… 13 , 14 Health assessments may offer an opportunity for general practitioners to gain a more comprehensive overview of the needs of people with dementia and inform developing care plans. A recent analysis of the use of health care by women with and without dementia 15 found that women with dementia had more GP attendances and fewer specialist attendances but were not more likely to receive health assessment, chronic disease management, or allied health services. Health assessments may be of particular value for people with dementia who have multiple complex health and social care needs.…”

Perceptions of people living with dementia regarding patient‐centred aspects of their care and caregiver support

“…Most people living with dementia live in the community and are supported by family caregivers 1 . People living with dementia also frequently access health care services to meet their complex health needs 2,3 . Therefore, the support needed to meet the needs of people living with dementia may come from both healthcare professionals as well as family caregivers.…”