TRAJECTORIES OF HEALTH SYSTEM USE AND SURVIVAL FOR COMMUNITY-DWELLING PERSONS WITH DEMENTIA: AN INCEPTION COHORT STUDY

Abstract

Internationally, health systems strive to enable persons with Alzheimer's and related dementias (hereafter, dementia) to remain at home to maximize their quality of life and, where appropriate, to reduce the use of costly inpatient health services. There is limited evidence describing long-term trajectories of health system use by persons with dementia as they remain in the community over time. Health administrative data from Ontario, Canada was used to identify a cohort of 62,622 community-dwelling adults aged 65 years or older with dementia on April 1, 2007. Individuals were followed for seven years and matched 1:1 to persons without dementia (controls) based on age, sex and comorbidities in order to compare trends in use of health services by setting over time. Health services included: acute care hospitalizations (including those with discharge delay); nursing home placement; and emergency department, home care, and physician visits. Rates and trends in health system use were compared between persons with dementia, as they remained alive and in the community, and controls. Trajectories of health system use were displayed visually using Sankey plots. After seven years, 49.0% of persons with dementia had spent time in a nursing home (6.8% controls) and 64.5% had died (30.0% controls). Overall, persons with dementia were more likely than controls to use health services; particularly home care (rate ratio (RR) 3.02, 95% confidence interval (CI) 2.93 to 3.11) and experience hospitalizations with discharge delay (RR 2.36, 95% CI (2.30 to 2.42)). As they remained in the community over time, persons with dementia used home care at an increasingly intensive rate (10.7% increase per year, p <0.001), but rates of acute care hospitalization remained stable (p=0.38). Persons with dementia experienced more emergency department visits than controls (RR=1.23, 95% CI (1.21 to 1.25)), however rates of increase over time were similar between the groups (p=0.27).