Abstract
BackgroundPatients with dementia have increased healthcare utilization and often have comorbid chronic conditions. It is not clear if the increase in utilization is driven by dementia, the comorbidities or both. The objective of this study was to describe the number and types of comorbid conditions in a population-based cohort of older adults with dementia and how the level of comorbidity impacts dementia-related and non-dementia-related health service utilization.MethodsThis study is a retrospective cohort study using multiple linked administrative databases to examine health service utilization and costs of 100,630 community-living older adults living with pre-existing dementia in Ontario, Canada. Comorbid conditions and health service utilization were measured using administrative data (physician visits, emergency department visits, hospitalizations, and homecare contacts).ResultsNearly all, 96.3 %, had at least one comorbid condition, while 18.4 % had five or more comorbid conditions. The most common comorbid conditions were hypertension (77.8 %), and arthritis (66.2 %). All types of utilization increased consistently with the number of comorbid conditions. The average number of dementia-related services tended to be similar across all levels of comorbidity while the average number of non-dementia related visits tended to increase with the level of comorbidity.ConclusionsComorbidities in community-living older adults with dementia are common and account for a substantial proportion of health service use and costs in this population. Our results suggest that comprehensive programs that take a holistic view to identify the needs of patients in the context of other comorbidities are required for persons with dementia living in the community.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0351-x) contains supplementary material, which is available to authorized users.
Highlights
Patients with dementia have increased healthcare utilization and often have comorbid chronic conditions
Data The administrative databases linked in this study include: the Registered Persons Database (RPDB) for basic demographic data on all individuals enrolled in the provincial insurance program; the OHIP claims database for physician visits; the Discharge Abstract Database (DAD) for all records of inpatient hospitalizations; the National Ambulatory Care Reporting System (NACRS) for all records of emergency department visits and other ambulatory contacts; the Same Day Surgery (SDS) database for same-day surgeries and procedures, the Home Care Database (HCD) for information on all homecare service records; and the Ontario Drug Benefits (ODB) claims database for all outpatient prescription claims
The average number of dementia-related services tended to be similar across all levels of comorbidity while the average number of non-dementia related visits tended to increase with the level of comorbidity
Summary
Patients with dementia have increased healthcare utilization and often have comorbid chronic conditions. About half of people with dementia live in the community [8], and the number is increasing [9] In this group there is a great reliance on informal care, in which family and friends are called upon to provide the majority of care [10]. This is often supported by home-care and community-based care services to provide effective continuing care for those people living in the community with dementia. With the demographic shift toward older populations, the number of people with dementia is projected to increase dramatically over the 25 years which will impact both formal and informal care needs [11]
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