Patterns of health service use in community living older adults with dementia and comorbid conditions: a population-based retrospective cohort study in Ontario, Canada

Abstract

Background: Patients 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.

Methods: This 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).

Results: Nearly 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.

Conclusions: Comorbidities 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.

Keywords: Community-living older adults; Comorbidity; Dementia; Health service costs; Health service utilization.

Fig. 1

a Average annual number of dementia-related and non-dementia-related General practitioner visits. b Average annual number of dementia-related and non-dementia-related specialist visits. c Average annual number of dementia-related and non-dementia-related emergency department visits. d Average annual number of dementia-related and non-dementia-related hospitalizations. e Average annual number of dementia-related and non-dementia-related homecare nursing visits by the number of comorbid conditions in 2008 and 2012. Black bars represent dementia-related utilization and grey bars represent non-dementia-related utilization

Fig. 2

a Average length of stay (LOS) for dementia-related and non-dementia-related medical or surgical hospital episodes by the number of comorbid conditions in 2008 and 2012. b Average length of stay (LOS) for dementia-related and non-dementia-related alternate level of care (ALC) hospital episodes by the number of comorbid conditions in 2008 and 2012. Black bars represent dementia-related LOS and grey bars represent non-dementia-related LOS

Fig. 3

Total health services costs in 2008 and 2012 (expressed in 2012 CDN dollars) by level of comorbidity and by service type

Fig. 4

Per patient health service use costs over 5 years (2008 to 2012) adjusted to 2012 CDN dollars for patients with 0, 1, 2, or 3 or more comorbid conditions (CC)