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

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.

Interactive Effects of Dementia Severity and Comorbidities on Medicare Expenditures

“…That said, our results showed that after controlling for other determinants of cost, dementia severity and comorbidities were both independently associated with higher costs. Consistent with existing studies that showed that comorbidities accounted for substantial proportion of healthcare use and costs, 19 we found that comorbidities were the strongest drivers of higher costs of care. Similar to an early study which examined interactive effect of dementia severity and comorbidities on cost, 25 we also did not find a substantial modifying effect of dementia severity and level of comorbidities on costs of care.…”

“…A recent study showed that while non-dementia related healthcare use and costs were increased with levels of comorbidities, dementia related healthcare use and costs were similar across all levels of comorbidities. 19 In future studies, closer examination into the drivers of different types of cost are much needed.…”

“…Some of the most common conditions, including hypertension, diabetes, congestive heart failure, coronary heart diseases, have been reported to be higher in dementia patients compared to others without dementia, although rates of other conditions such as chronic kidney disease and cancer have been reported to be lower. 1–19 …”

Cardiovascular and metabolic comorbidities in patients with Alzheimer's disease and vascular dementia compared to a psychiatric control cohort

“…Recent studies have focused on the number of comorbidities and hospitalization rates in the UK and Canada. These studies showed that an increased number of comorbid disorders led to a higher frequency of hospitalization, although neither study differentiated between psychiatric or somatic departments …”

Multimorbidity, dementia and health care in older people:a population-based cohort study

“…Although the age-related natures of both multimorbidity and dementia are well known, few studies have examined how the interplay between age, multimorbidity and dementia influences health outcomes or the capacity for independent living. Available studies demonstrate that increased morbidity burden is associated with higher prevalence and severity of dementia and cognitive impairment, [8][9][10][11][21][22][23][24] but they are limited by their relatively small sample sizes and lack of longitudinal follow-up for clinical outcomes or resource use. Possible explanations for the high prevalence of comorbidities in people with dementia include common risk factors (e.g., unhealthy diet), a common causal pathway (e.g., atherosclerosis), adverse effects of medications used to treat medical morbidity, or other iatrogenic factors (e.g., subclinical stroke following angioplasty for coronary disease).…”