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

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037485
Author(s):  
Susan E Bronskill ◽  
Laura C Maclagan ◽  
Jennifer D Walker ◽  
Jun Guan ◽  
Xuesong Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Home Care ◽  
Health System ◽  
Service Use ◽  
Long Term Care ◽  
Community Dwelling ◽  
Term Care ◽  
System Use ◽  
Over Time

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.

scholarly journals Trends in prevalence, incidence, health system use and cost by persons with dementia in Ontario from 2004 and 2013: a population-based study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Susan Bronskill ◽  
Jun Guan ◽  
Marian Vermeulen ◽  
Erika Yates ◽  
Ryan Ng ◽  
...  
Keyword(s):  
Health System ◽  
Service Use ◽  
Long Term Care ◽  
Population Based ◽  
P Value ◽  
Term Care ◽  
Health Administrative Data ◽  
System Use ◽  
Over Time

ABSTRACTObjectiveEfforts to enable persons with dementia to remain at home longer, and to reduce use of costly acute care resources, are at the forefront of policy agendas internationally. Foundational to planning appropriate health system supports is the ongoing, comparable and accurate estimation of the prevalence and incidence of dementia across regions, as well as associated patterns of health services use and cost. Our objective was to explore emerging approaches to using population data in dementia research and demonstrate the policy contribution of the resulting new knowledge. ApproachUsing population-based health administrative data and an algorithm that was validated using electronic medical records, we developed a series of repeated, cross-sectional cohort studies to examine trends in dementia prevalence, incidence and publicly-funded health service use and costs between 2004/05 and 2013/14 among adults aged 65 years and older in Ontario, Canada. Trends in yearly rates of health service use were assessed using regression models for serially correlated data and compared to a 1:1 matched control group based on age, sex, geographic region and comorbidity level. ResultsOver time, age- and sex-adjusted prevalence of dementia increased by 18.2% (from 63.0 to 74.5 per 1,000 persons; p-value < 0.001) and age- and sex-adjusted incidence decreased slightly (from 18.2 to 17.0 per 1,000 persons; p-value = 0.05). Community-dwelling persons with dementia were more likely than matched controls to be placed in long-term care (11.8% vs. 1.5% in 2013; p<0.001) and use home care (45.8% vs 23.2%; p<0.001) but equally likely to visit family physicians (93.9% vs. 94.8% in 2013) and specialists (87.1% vs. 89.4%). Median costs associated with one year of health system use were $19,468 (interquartile range (IQR) $4,490 to $47,726) for prevalent cases in 2012/13 and $16,549 (IQR $5,070 to $47,899) for incident cases. Long-term care and hospital care accounted for the largest portion of total costs in both groups. ConclusionThe prevalence of dementia has increased in Ontario, Canada over time and, given slightly declining incidence rates, is likely attributable to improved survival. Surveillance of dementia with health administrative data is a cost-effective tool for describing and monitoring trends in incidence and prevalence over time, and for supporting health system capacity planning. This comparative information is critical to understanding the impact of policy decisions designed to address dementia-related health care needs at a population level.

O2-04-03: Health system use, transitions to long-term care, and survival among community-dwelling older adults with dementia in ontario, canada

2015 ◽  
Vol 11 (7S_Part_4) ◽  
pp. P180-P181
Author(s):  
Susan Bronskill ◽  
Jennifer Walker ◽  
Colleen Maxwell ◽  
Erika Yates ◽  
Nadia Gunraj
Keyword(s):  
Older Adults ◽  
Health System ◽  
Long Term Care ◽  
Community Dwelling ◽  
Term Care ◽  
System Use ◽  
Community Dwelling Older Adults

scholarly journals TRAJECTORIES OF HEALTH SYSTEM USE AND TRANSITIONS IN OLDER ADULTS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Susan E Bronskill ◽  
Laura C Maclagan ◽  
Jennifer Walker ◽  
Jun Guan ◽  
Xuesong Wang ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Health System ◽  
Capacity Planning ◽  
Community Dwelling ◽  
Service Needs ◽  
Future Health ◽  
System Use ◽  
Community Dwelling Older Adults ◽  
Over Time

Abstract Health systems strive to enable persons with Alzheimer’s and related dementias to remain at home to maximize their quality of life. There is limited evidence describing long-term trajectories of health system use by persons with dementia as they remain in the community over time. A cohort of 62,622 community-dwelling older adults was followed for seven years and matched to persons without dementia (controls) based on age, sex and comorbidities. Overall, persons with dementia were more likely than controls to use health services, particularly home care and hospitalizations with discharge delay; and were more likely to be admitted to a nursing home. As they remained in the community over time, persons with dementia used home care at an increasingly intensive rate. Our approach to examine trajectories of health system use among persons with dementia is of particular value to capacity planning initiatives to anticipate future health service needs of this population.

Trends in the informal and formal home-care use of older adults in the Netherlands between 1992 and 2012

2015 ◽  
Vol 36 (9) ◽  
pp. 1870-1890 ◽  
Author(s):  
JOUKJE C. SWINKELS ◽  
BIANCA SUANET ◽  
DORLY J. H. DEEG ◽  
MARJOLEIN I. BROESE VAN GROENOU
Keyword(s):  
Logistic Regression ◽  
Home Care ◽  
Informal Care ◽  
Long Term Care ◽  
Substitution Effect ◽  
Large Decrease ◽  
Term Care ◽  
Multi Level ◽  
Over Time

ABSTRACTThis study investigates trends in, and the interdependence of, the use of informal and formal home care of community-dwelling older people over the last two decades in the context of governmental reform of long-term care services and modernisation of informal relationships. Seven observations of the Longitudinal Aging Study Amsterdam covering the time span between 1992 and 2012 were analysed using multi-level logistic regression analysis. The sample entailed 9,585 observations from 3,574 respondents, aged between 65 and 85 years and living independently at each time of measurement. Measures included formal and informal care use, health, physical and cognitive limitations, socio-demographics, partner status, social network, privately paid help and sense of mastery. Results showed that between 1992 and 2012, formal home-care use increased slightly while there was a large decrease in the use of informal care. Multivariate multi-level logistic regression analyses showed a substitution effect between formal and informal care use which decreased over time. Analyses also showed improved cognitive functioning, increased partner availability and social network size, as well as increased use of privately paid care over time. Nevertheless, these positive trends did not explain the large decrease in informal care use. The results regarding informal care use suggest a societal trend of weakened informal solidarity, reflecting increased individualisation and increased availability of formal home care. The decreased substitution effect suggests that, in agreement with current reforms of long-term care, complementary or supplementary forms of care use may be more common in the near future.

scholarly journals Use of Long-Term Care Decreased Over Time Among the Oldest-Old With and Without Dementia - A Register-Based Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 995-996
Author(s):  
Mari Aaltonen ◽  
Leena Forma ◽  
Jutta Pulkki ◽  
Jani Raitanen ◽  
Marja Jylhä
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Negative Binomial ◽  
Oldest Old ◽  
Age Groups ◽  
Term Care ◽  
Total Study Population ◽  
Health And Social Care ◽  
Over Time

Abstract Care policies for older adults emphasize aging-in-place and home care over residential long-term care (LTC). We explore how the use of residential LTC in the last five years of life among people with and without dementia changed between those who died in 2001, 2007, 2013, and 2017 in Finland. Retrospective data drawn from the national health and social care registers include all those who died aged 70+ in 2007, 2013, and 2017, plus a 40% random sample from 2001 (N=128 050). Negative binomial regression analysis was used to estimate the association of dementia with LTC use during the last five years of life (1825 days). The independent variables included dementia, age, marital status, annual income, education, and chronic conditions. In the total study population, the proportion of LTC users and the mean number of days in LTC increased until 2013, after which it decreased. Changes in LTC use differed between different age groups and by dementia status. Over time, the decrease in round-the-clock LTC use was steep in those aged 90≤ with dementia and in people aged 80≤ without dementia. The individual factors related to morbidity and sociodemographic factors did not explain these results. The changes in LTC care policy may have contributed to the decrease in LTC use among the oldest. However, according to national statistics, the availability of formal home care has not increased. This development may suggest that the oldest-old and those with dementia – a highly vulnerable group – are left without proper care.

scholarly journals Influence of social relationship domains and their combinations on incident dementia: a prospective cohort study

2017 ◽  
Vol 72 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Tami Saito ◽  
Chiyoe Murata ◽  
Masashige Saito ◽  
Tokunori Takeda ◽  
Katsunori Kondo
Keyword(s):  
Cohort Study ◽  
Social Relationships ◽  
Prospective Cohort ◽  
Social Relationship ◽  
Long Term Care ◽  
Community Dwelling ◽  
Term Care ◽  
Incident Dementia ◽  
The Social

BackgroundSocial relationships consist of mutually related but distinct dimensions. It remains unclear how these domains independently contribute to incident dementia. This large-scale, prospective cohort study examines associations between the social relationship domains as well as their combinations and incident dementia among community-dwelling older adults.MethodsWe analysed data from 13 984 community-dwelling adults aged 65+ without long-term care needs living in Aichi prefecture in Japan. Incident dementia was assessed based on the Long-term Care Insurance records, followed for 3436 days from the baseline survey conducted in 2003. Three social relationships domains (social support, social networks and social activities) were further divided into a total of eight subdomains. A social relationship diversity score was calculated using the social relationship domains which were significantly related to incident dementia.ResultsA Cox proportional hazards model showed that being married, exchanging support with family members, having contact with friends, participating in community groups and engaging in paid work were related to a lower likelihood of developing incident dementia, controlling for covariates and other social relationship domains. The diversity scores, ranging from 0 to 5, were linearly associated with incident dementia (p<0.001), and those who scored highest were 46% less likely to develop incident dementia compared with those in the lowest category.ConclusionsOur findings revealed five social relationship subdomains which were negatively related to incident dementia, suggesting that dementia may potentially be prevented by enhancing these social relationships. Future studies should examine independent pathways between each social relationship domain and incident dementia.

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