Patients living alone with dementia: course of health‐related quality of life over time and the impact of collaborative care in Germany

Abstract

AbstractBackgroundLittle is known about the progression of patient‐reported outcomes in community‐dwelling people living alone with cognitive impairment (PLACI) and the efficacy and cost‐effectiveness of collaborative care models, initiating evidence‐based care and support for this vulnerable subgroup. Thus, this study aims to demonstrate the longitudinal course of patient‐reported outcomes and assess the efficacy and cost‐effectiveness of collaborative care in PLACI compared to those not living alone.MethodDelpHi‐MV (Dementia: Life‐ and person‐centred help in Mecklenburg‐Western Pomerania) is a German general practitioner‐based, randomized controlled intervention trial. The present analyses are based on longitudinal (24 months) data of 352 patients (≥70 years, community‐dwelling). Patient‐reported outcomes were assessed using the SF‐12, dividing patients' health‐related quality of life (HRQoL) into mental and physical parts. Descriptive statistics were used to demonstrate HRQoL longitudinally. The efficacy and cost‐effectiveness of the collaborative care model were assessed by multivariate regression models and by cost‐effectiveness‐acceptability curves, separately for PLACI vs those living not alone.ResultN = 178 (51%) patients were living alone and more likely female (73% vs 49%) and older (81 years vs 79 years) than those living not alone. Considering PLACI only, mental and physical HRQoL decreased over time (‐2.4 and ‐2.2) without collaborative care and increased (+1.4 and +2.5) with collaborative care. Multivariate models confirmed the significant positive impact of collaborative care on mental HRQoL (b = +3.1, p = 0.032) over time. The probability of cost‐effectiveness was 96% at a willingness‐to‐pay of 40,000€ /QALY for PLACI, much higher than in those living not alone (26%).ConclusionHRQoL would decrease over time in PLACI. Collaborative care could improve patients' everyday lives, especially mental health. Thus, when such models are implemented, health policy could gain the highest cost savings and effects on HRQoL in PLACI.