Comparison of the Quality of Chronic Disease Management Between Adults With and Without Dementia

Abstract

IMPORTANCE Adults with dementia may experience poorer quality of chronic disease management because of the difficulty in reporting symptoms and engaging in shared decision-making associated with cognitive impairment. OBJECTIVE To compare the quality of chronic disease management received by adults with and without dementia. DESIGN, SETTING, AND PARTICIPANTS For this cross-sectional study, nationally representative data from noninstitutionalized patients 65 years or older were obtained from the 2002-2015 Medical Expenditure Panel Survey. The control group comprised adults of similarly limited life expectancy without dementia comprised . Data analysis was performed in June 2020. EXPOSURES Dementia diagnosis. MAIN OUTCOMES AND MEASURES Quality of chronic disease management based on 14 individual quality indicators. The association between dementia status and the quality of chronic disease management (3 composite categories: preventive care, diabetes care, and medication treatment) was examined using multivariable linear regression models. Survey weights, sampling strata, and primary sampling unit variables were used to produce national estimates adjusted for nonresponse. RESULTS This study included 2506 adults (mean [SD] age, 81.4 [4.7] years; 1259 [49.3%] female;1243 [50.7%] male), of whom 1335 (53.3%) had a diagnosis of dementia and 1171 (46.7%) did not have a diagnosis of dementia. After adjusting for potential confounders, adults with dementia received lower-quality preventive care compared with adults of similar life expectancy without dementia (adjusted absolute difference [aAD], −6.1 percentage points [pp]; 95% CI, −9.7 to −2.5 pp; P = .001). We found no evidence that the quality of care differed in diabetes care (aAD, 1.7 pp; 95% CI, −4.5 to 7.9 pp; P = .59) and medication treatment (aAD, 1.0 pp; 95% CI, −5.0 to 7.0 pp; P = .75). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, the quality of chronic disease management for adults with dementia was not substantially different from that for those without dementia despite potential barriers. Future studies are warranted to gain a better understanding of the underlying mechanism of these findings for preventive care.

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